Difference between revisions of "Gestational trophoblastic neoplasia"
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==ESMO== | ==ESMO== | ||
*'''2013:''' Seckl et al. [https://www.esmo.org/Guidelines/Gynaecological-Cancers/Gestational-Trophoblastic-Disease Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up] | *'''2013:''' Seckl et al. [https://www.esmo.org/Guidelines/Gynaecological-Cancers/Gestational-Trophoblastic-Disease Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up] | ||
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==[https://www.nccn.org/ NCCN]== | ==[https://www.nccn.org/ NCCN]== | ||
*[https://www.nccn.org/professionals/physician_gls/pdf/gtn.pdf NCCN Guidelines - Gestational Trophoblastic Neoplasia] | *[https://www.nccn.org/professionals/physician_gls/pdf/gtn.pdf NCCN Guidelines - Gestational Trophoblastic Neoplasia] | ||
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=Low-risk disease, all lines of therapy= | =Low-risk disease, all lines of therapy= | ||
==Dactinomycin monotherapy {{#subobject:415b07|Regimen=1}}== | ==Dactinomycin monotherapy {{#subobject:415b07|Regimen=1}}== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:fcf204|Variant=1}}=== | ===Regimen {{#subobject:fcf204|Variant=1}}=== | ||
{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
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|- | |- | ||
|} | |} | ||
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Dactinomycin (Cosmegen)]] 1.25 mg/m<sup>2</sup> IV push once on day 1 | *[[Dactinomycin (Cosmegen)]] 1.25 mg/m<sup>2</sup> 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"''' | '''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"''' | ||
| − | + | </div></div> | |
===References=== | ===References=== | ||
# Osathanondh R, Goldstein DP, Pastorfide GB. Actinomycin D as the primary agent for gestational trophoblastic disease. Cancer. 1975 Sep;36(3):863-6. [https://doi.org/10.1002/1097-0142(197509)36:3%3C863::AID-CNCR2820360306%3E3.0.CO;2-G link to original article] [https://pubmed.ncbi.nlm.nih.gov/171055 PubMed] | # Osathanondh R, Goldstein DP, Pastorfide GB. Actinomycin D as the primary agent for gestational trophoblastic disease. Cancer. 1975 Sep;36(3):863-6. [https://doi.org/10.1002/1097-0142(197509)36:3%3C863::AID-CNCR2820360306%3E3.0.CO;2-G link to original article] [https://pubmed.ncbi.nlm.nih.gov/171055 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. [https://doi.org/10.1200/JCO.2010.30.4386 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068058/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/21263100 PubMed] NCT00003702 | # '''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. [https://doi.org/10.1200/JCO.2010.30.4386 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068058/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/21263100 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. [https://doi.org/10.1016/j.ygyno.2020.05.013 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432963/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/32460997 PubMed] NCT01535053 | # '''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. [https://doi.org/10.1016/j.ygyno.2020.05.013 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432963/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/32460997 PubMed] NCT01535053 | ||
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==EMA-CO {{#subobject:418f07|Regimen=1}}== | ==EMA-CO {{#subobject:418f07|Regimen=1}}== | ||
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EMA-CO: '''<u>E</u>'''toposide, '''<u>M</u>'''ethotrexate, '''<u>A</u>'''ctinomycin D, '''<u>C</u>'''yclophosphamide, '''<u>O</u>'''ncovin (Vincristine) | EMA-CO: '''<u>E</u>'''toposide, '''<u>M</u>'''ethotrexate, '''<u>A</u>'''ctinomycin D, '''<u>C</u>'''yclophosphamide, '''<u>O</u>'''ncovin (Vincristine) | ||
| + | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:zgc204|Variant=1}}=== | ===Regimen {{#subobject:zgc204|Variant=1}}=== | ||
{| class="wikitable" style="width: 60%; text-align:center;" | {| class="wikitable" style="width: 60%; text-align:center;" | ||
| Line 71: | Line 68: | ||
|- | |- | ||
|} | |} | ||
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Etoposide (Vepesid)]] | *[[Etoposide (Vepesid)]] | ||
| Line 77: | Line 75: | ||
*[[Cyclophosphamide (Cytoxan)]] | *[[Cyclophosphamide (Cytoxan)]] | ||
*[[Vincristine (Oncovin)]] | *[[Vincristine (Oncovin)]] | ||
| + | </div></div> | ||
===References=== | ===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. [https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.1991.tb10369.x link to original article] [https://pubmed.ncbi.nlm.nih.gov/1651757 PubMed] | # 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. [https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.1991.tb10369.x link to original article] [https://pubmed.ncbi.nlm.nih.gov/1651757 PubMed] | ||
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==Mercaptopurine & Methotrexate {{#subobject:d34408|Regimen=1}}== | ==Mercaptopurine & Methotrexate {{#subobject:d34408|Regimen=1}}== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:a1c0ec|Variant=1}}=== | ===Regimen {{#subobject:a1c0ec|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
| Line 92: | Line 90: | ||
|} | |} | ||
''Note: this is of historic interest.'' | ''Note: this is of historic interest.'' | ||
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Mercaptopurine (6-MP)]] | *[[Mercaptopurine (6-MP)]] | ||
*[[Methotrexate (MTX)]] | *[[Methotrexate (MTX)]] | ||
| + | </div></div> | ||
===References=== | ===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. [https://doi.org/10.1056/nejm195807102590204 link to original article] [https://pubmed.ncbi.nlm.nih.gov/13566422 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. [https://doi.org/10.1056/nejm195807102590204 link to original article] [https://pubmed.ncbi.nlm.nih.gov/13566422 PubMed] | ||
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==Methotrexate monotherapy {{#subobject:d33308|Regimen=1}}== | ==Methotrexate monotherapy {{#subobject:d33308|Regimen=1}}== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:b3d0ec|Variant=1}}=== | ===Regimen {{#subobject:b3d0ec|Variant=1}}=== | ||
{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
| Line 134: | Line 133: | ||
|} | |} | ||
''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.'' | ''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.'' | ||
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====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 | ||
| − | |||
'''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"''' | '''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"''' | ||
| − | + | </div></div> | |
===References=== | ===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. [https://doi.org/10.3181/00379727-93-22757 link to original article] [https://pubmed.ncbi.nlm.nih.gov/13379512 PubMed] | # 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. [https://doi.org/10.3181/00379727-93-22757 link to original article] [https://pubmed.ncbi.nlm.nih.gov/13379512 PubMed] | ||
| Line 145: | Line 144: | ||
# '''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. [https://doi.org/10.1200/JCO.2010.30.4386 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068058/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/21263100 PubMed] NCT00003702 | # '''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. [https://doi.org/10.1200/JCO.2010.30.4386 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068058/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/21263100 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. [https://doi.org/10.1016/j.ygyno.2020.05.013 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432963/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/32460997 PubMed] NCT01535053 | # '''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. [https://doi.org/10.1016/j.ygyno.2020.05.013 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432963/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/32460997 PubMed] NCT01535053 | ||
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[[Category:Gestational trophoblastic neoplasia regimens]] | [[Category:Gestational trophoblastic neoplasia regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Gynecologic cancers]] | [[Category:Gynecologic cancers]] | ||
Revision as of 23:26, 28 February 2023
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) |
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
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