Comparison of methotrexate, actinomycin D, and etoposide for treating low-risk gestational trophoblastic neoplasia
International Journal of Gynecology & Obstetrics, 08/10/2012
Baptista AM et al. – Etoposide was the most effective regimen for treating metastatic and non–metastatic low–risk gestational trophoblastic neoplasia (LRGTN).Methods
- A prospective study was conducted at a referral center in Rio de Janeiro, Brazil.
- Patients presenting with metastatic or non–metastatic LRGTN (risk score ≤6) in non–probabilistic sampling were assigned to 1 of 3 treatments: methotrexate with folinic acid rescue (MTX–CF; n=20); actinomycin D (n=20); and etoposide (n=20).
- Women with less than 1year of disease–free follow–up after the first normal human chorionic gonadotropin (hCG) value were excluded.
- Outcome measures included primary remission rate; resistance to primary and sequential chemotherapy; period between treatment initiation and remission (hCG response); and prevalence of toxic effects.
- Primary remission was achieved by 48 patients (80.0%).
- The remission rate with etoposide was 100.0%, while the rates with actinomycin D and MTX–CF were 90.0% and 50.0%, respectively.
- Efficacy of etoposide was significantly greater than the other 2 agents (P<0.001).
- Alopecia was the most frequent adverse effect caused by etoposide.
- Common to all protocols were stomatitis, nausea, and vomiting.
- Mean time intervals between beginning treatment and remission were similar and all 60 participants survived.