Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia
Abstract Background Little data exists predicting the resistance to actinomycin D (Act-D) single-agent for gestational trophoblastic neoplasia (GTN). The objective was to determine the overall success of pulse Act-D and the factors predictive of resistance to pulse Act-D in the treatment of low-risk...
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doaj-e3c4bd48531d4df8858aa9fc3c1cd1702020-11-24T21:23:12ZengBMCBMC Cancer1471-24072018-05-011811610.1186/s12885-018-4512-5Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasiaLei Li0Xirun Wan1Fengzhi Feng2Tong Ren3Junjun Yang4Jun Zhao5Fang Jiang6Yang Xiang7Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical CollegeDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical CollegeDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical CollegeDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical CollegeDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical CollegeDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical CollegeDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical CollegeDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical CollegeAbstract Background Little data exists predicting the resistance to actinomycin D (Act-D) single-agent for gestational trophoblastic neoplasia (GTN). The objective was to determine the overall success of pulse Act-D and the factors predictive of resistance to pulse Act-D in the treatment of low-risk, non-choriocarcinoma post-molar GTN. Methods From January 2013 to October 2016, according to the FIGO criteria for the diagnosis of post-molar disease and the FIGO risk-factor scoring system for GTN, a total of 135 patients with post-molar non-choriocarcinoma GTN who were chemotherapy-naive with a FIGO score < 7 were treated with single-agent pulse Act-D as a first-line regimen, in Peking Union Medical College Hospital. The pulse Act-D regimen is defined as 1.25 mg/m2 (max 2 mg) IV push every other week. All patients were followed until May 2017. Epidemiological and clinical data were compared between patients with remission and resistance to Act-D to determine predictive factors by univariate and multivariate analysis. Results Ninety-six of 135 patients (71.1%) achieved complete remission after first-line chemotherapy of pulse Act-D. In multivariate analysis, existing invasive uterine lesions observed by pre-chemotherapy transvaginal ultrasound (odds ratio [OR] 7.5, 95% confidence intervals [CI] 2.7–20.8), FIGO score ≥ 5 (OR 15.2, 95% CI 1.5–156.1) and pre-chemotherapy levels of β-hCG ≥ 4000 IU/L (OR 3.1, 95% CI 1.2–8.3) were independent high-risk factors predicting resistance to pulse Act-D as single-agent chemotherapy. During follow-up, no relapse, treatment-associated serious adverse events, or death occurred. Conclusions As first-line chemotherapy, pulse Act-D was effective and tolerable for patients with low-risk post-molar non-choriocarcinoma. Existing invasive uterine lesions observed by pre-chemotherapy transvaginal ultrasound, a FIGO score ≥ 5, and pre-chemotherapy levels of β-hCG ≥ 4000 IU/L were independent factors for resistance to pulse Act-D.http://link.springer.com/article/10.1186/s12885-018-4512-5Actinomycin DGestational trophoblastic neoplasiaTransvaginal ultrasoundβ-hCG |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lei Li Xirun Wan Fengzhi Feng Tong Ren Junjun Yang Jun Zhao Fang Jiang Yang Xiang |
spellingShingle |
Lei Li Xirun Wan Fengzhi Feng Tong Ren Junjun Yang Jun Zhao Fang Jiang Yang Xiang Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia BMC Cancer Actinomycin D Gestational trophoblastic neoplasia Transvaginal ultrasound β-hCG |
author_facet |
Lei Li Xirun Wan Fengzhi Feng Tong Ren Junjun Yang Jun Zhao Fang Jiang Yang Xiang |
author_sort |
Lei Li |
title |
Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia |
title_short |
Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia |
title_full |
Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia |
title_fullStr |
Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia |
title_full_unstemmed |
Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia |
title_sort |
pulse actinomycin d as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia |
publisher |
BMC |
series |
BMC Cancer |
issn |
1471-2407 |
publishDate |
2018-05-01 |
description |
Abstract Background Little data exists predicting the resistance to actinomycin D (Act-D) single-agent for gestational trophoblastic neoplasia (GTN). The objective was to determine the overall success of pulse Act-D and the factors predictive of resistance to pulse Act-D in the treatment of low-risk, non-choriocarcinoma post-molar GTN. Methods From January 2013 to October 2016, according to the FIGO criteria for the diagnosis of post-molar disease and the FIGO risk-factor scoring system for GTN, a total of 135 patients with post-molar non-choriocarcinoma GTN who were chemotherapy-naive with a FIGO score < 7 were treated with single-agent pulse Act-D as a first-line regimen, in Peking Union Medical College Hospital. The pulse Act-D regimen is defined as 1.25 mg/m2 (max 2 mg) IV push every other week. All patients were followed until May 2017. Epidemiological and clinical data were compared between patients with remission and resistance to Act-D to determine predictive factors by univariate and multivariate analysis. Results Ninety-six of 135 patients (71.1%) achieved complete remission after first-line chemotherapy of pulse Act-D. In multivariate analysis, existing invasive uterine lesions observed by pre-chemotherapy transvaginal ultrasound (odds ratio [OR] 7.5, 95% confidence intervals [CI] 2.7–20.8), FIGO score ≥ 5 (OR 15.2, 95% CI 1.5–156.1) and pre-chemotherapy levels of β-hCG ≥ 4000 IU/L (OR 3.1, 95% CI 1.2–8.3) were independent high-risk factors predicting resistance to pulse Act-D as single-agent chemotherapy. During follow-up, no relapse, treatment-associated serious adverse events, or death occurred. Conclusions As first-line chemotherapy, pulse Act-D was effective and tolerable for patients with low-risk post-molar non-choriocarcinoma. Existing invasive uterine lesions observed by pre-chemotherapy transvaginal ultrasound, a FIGO score ≥ 5, and pre-chemotherapy levels of β-hCG ≥ 4000 IU/L were independent factors for resistance to pulse Act-D. |
topic |
Actinomycin D Gestational trophoblastic neoplasia Transvaginal ultrasound β-hCG |
url |
http://link.springer.com/article/10.1186/s12885-018-4512-5 |
work_keys_str_mv |
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