Difference between revisions of "Gestational trophoblastic neoplasia"
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Warner-admin (talk | contribs) m (Text replacement - "'''contains verified protocol'''" to "'''contains dosing details in manuscript'''") |
Warner-admin (talk | contribs) m (Text replacement - "to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm." to "to our knowledge, this regimen was not tested as an experimental arm in an RCT in this context, prior to becoming a standard comparator arm.") |
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− | ''Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.'' | + | ''Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT in this context, prior to becoming a standard comparator arm.'' |
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Methotrexate (MTX)]] 30 mg/m<sup>2</sup> IM once on day 1 | *[[Methotrexate (MTX)]] 30 mg/m<sup>2</sup> IM once on day 1 |
Revision as of 00:50, 2 September 2022
4 regimens on this page
6 variants on this page
|
Guidelines
ESMO
- 2013: Seckl et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
NCCN
Low-risk disease, all lines of therapy
Dactinomycin monotherapy
Regimen
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Osathanondh et al. 1975 | 1965-1973 | Non-randomized (RT) | ||
Osborne et al. 2011 (GOG 0174) | 1999-2007 | Phase 3 (E-switch-ic) | Methotrexate | Seems to have superior CR rate |
Schink et al. 2020 (GOG 275) | 2012-2016 | Phase 3 (C) | Methotrexate; multi-day | Did not meet primary endpoint of CR rate |
Chemotherapy
- Dactinomycin (Cosmegen) 1.25 mg/m2 IV push once on day 1
14-day cycles "until the βhCG assay had reached the institutional normal, or until either a rise or plateau in the βhCG level was observed"
References
- Osathanondh R, Goldstein DP, Pastorfide GB. Actinomycin D as the primary agent for gestational trophoblastic disease. Cancer. 1975 Sep;36(3):863-6. link to original article PubMed
- GOG 0174: Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, Provencher D, Scott Miller D, Covens AL, Lage JM. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Mar 1;29(7):825-31. Epub 2011 Jan 24. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00003702
- GOG 275: Schink JC, Filiaci V, Huang HQ, Tidy J, Winter M, Carter J, Anderson N, Moxley K, Yabuno A, Taylor SE, Kushnir C, Horowitz N, Miller DS. An international randomized phase III trial of pulse actinomycin-D versus multi-day methotrexate for the treatment of low risk gestational trophoblastic neoplasia; NRG/GOG 275. Gynecol Oncol. 2020 Aug;158(2):354-360. Epub 2020 May 24. link to original article link to PMC article PubMed NCT01535053
EMA-CO
EMA-CO: Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Oncovin (Vincristine)
Regimen
Study | Years of enrollment | Evidence |
---|---|---|
Newlands et al. 1991 | 1979-1989 | Non-randomized (RT) |
Chemotherapy
- Etoposide (Vepesid)
- Methotrexate (MTX)
- Dactinomycin (Cosmegen)
- Cyclophosphamide (Cytoxan)
- Vincristine (Oncovin)
References
- Newlands ES, Bagshawe KD, Begent RH, Rustin GJ, Holden L. Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989. Br J Obstet Gynaecol. 1991 Jun;98(6):550-7. link to original article PubMed
Mercaptopurine & Methotrexate
Regimen
Study | Evidence |
---|---|
Li et al. 1958 | Pilot |
Note: this is of historic interest.
Chemotherapy
References
- Li MC, Hertz R, Bergenstal DM. Therapy of choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists. N Engl J Med. 1958 Jul 10;259(2):66-74. link to original article PubMed
Methotrexate monotherapy
Regimen
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Li et al. 1956 | NR | Pilot | ||
Li et al. 1958 | 1955-1957 | Pilot | ||
Homesley et al. 1988 | NR in abstract | Phase 2 | ||
Osborne et al. 2011 (GOG 0174) | 1999-2007 | Phase 3 (C) | Dactinomycin | Seems to have inferior CR rate |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT in this context, prior to becoming a standard comparator arm.
Chemotherapy
- Methotrexate (MTX) 30 mg/m2 IM once on day 1
7-day cycles "until the βhCG assay had reached the institutional normal, or until either a rise or plateau in the βhCG level was observed"
References
- Li MC, Hertz R, Spencer DB. Effect of methotrexate therapy upon choriocarcinoma and chorioadenoma. Proc Soc Exp Biol Med. 1956 Nov;93(2):361-6. link to original article PubMed
- Li MC, Hertz R, Bergenstal DM. Therapy of choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists. N Engl J Med. 1958 Jul 10;259(2):66-74. link to original article PubMed
- Homesley HD, Blessing JA, Rettenmaier M, Capizzi RL, Major FJ, Twiggs LB. Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Obstet Gynecol. 1988 Sep;72(3 Pt 1):413-8. link to original article PubMed
- GOG 0174: Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, Provencher D, Scott Miller D, Covens AL, Lage JM. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Mar 1;29(7):825-31. Epub 2011 Jan 24. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00003702
- GOG 275: Schink JC, Filiaci V, Huang HQ, Tidy J, Winter M, Carter J, Anderson N, Moxley K, Yabuno A, Taylor SE, Kushnir C, Horowitz N, Miller DS. An international randomized phase III trial of pulse actinomycin-D versus multi-day methotrexate for the treatment of low risk gestational trophoblastic neoplasia; NRG/GOG 275. Gynecol Oncol. 2020 Aug;158(2):354-360. Epub 2020 May 24. link to original article link to PMC article PubMed NCT01535053