TY - JOUR
T1 - Salvage chemotherapy for gestational trophoblastic neoplasia
T2 - Utility or futility?
AU - Essel, Kathleen G.
AU - Bruegl, Amanda
AU - Gershenson, David M.
AU - Ramondetta, Lois M.
AU - Naumann, R. Wendel
AU - Brown, Jubilee
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/7
Y1 - 2017/7
N2 - Objective To determine the efficacy of chemotherapy after failed initial treatment in patients with high risk gestational trophoblastic neoplasia (GTN). Methods We performed a retrospective IRB-approved chart review of all patients with GTN seen at a single institution from 1985 to 2015, including all patients who failed initial treatment. We summarized clinical characteristics with descriptive statistics and estimated progression-free survival (PFS) and overall survival (OS) with the Kaplan-Meier method. Results Of 68 identified patients, 38 required > 2 chemotherapy regimens. Patients were treated for GTN (n = 53), including choriocarcinoma, persistent GTN, and invasive mole; for placental site trophoblastic tumor (PSTT) (n = 5); and for intermediate trophoblastic tumor (ITT) (n = 10). Patients with GTN had a median of 2 salvage regimens, median PFS of 4.0 months, and median OS was not reached at median follow-up of 71.2 months. Active regimens included EMACO, MAC, BEP, platinum- and etoposide-based combination therapies, and ICE; 8 of 53 patients died of disease (DOD). Patients with PSTT had a median of 3 salvage regimens, median PFS of 2.8 months, and median OS of 38.8 months. Active regimens included ICE and EMA-EP; 4 of 5 patients DOD. Patients with ITT had a median of 3 salvage regimens, median PFS of 4.1 months, and median OS of 38.2 months. Active regimens included liposomal doxorubicin, platinum-containing regimens, EMA-CO, and EMA-EP; 7 of 10 patients DOD. Conclusions Several salvage chemotherapy regimens demonstrate activity in high risk GTN. Multiple regimens may be required and cure is not universal.
AB - Objective To determine the efficacy of chemotherapy after failed initial treatment in patients with high risk gestational trophoblastic neoplasia (GTN). Methods We performed a retrospective IRB-approved chart review of all patients with GTN seen at a single institution from 1985 to 2015, including all patients who failed initial treatment. We summarized clinical characteristics with descriptive statistics and estimated progression-free survival (PFS) and overall survival (OS) with the Kaplan-Meier method. Results Of 68 identified patients, 38 required > 2 chemotherapy regimens. Patients were treated for GTN (n = 53), including choriocarcinoma, persistent GTN, and invasive mole; for placental site trophoblastic tumor (PSTT) (n = 5); and for intermediate trophoblastic tumor (ITT) (n = 10). Patients with GTN had a median of 2 salvage regimens, median PFS of 4.0 months, and median OS was not reached at median follow-up of 71.2 months. Active regimens included EMACO, MAC, BEP, platinum- and etoposide-based combination therapies, and ICE; 8 of 53 patients died of disease (DOD). Patients with PSTT had a median of 3 salvage regimens, median PFS of 2.8 months, and median OS of 38.8 months. Active regimens included ICE and EMA-EP; 4 of 5 patients DOD. Patients with ITT had a median of 3 salvage regimens, median PFS of 4.1 months, and median OS of 38.2 months. Active regimens included liposomal doxorubicin, platinum-containing regimens, EMA-CO, and EMA-EP; 7 of 10 patients DOD. Conclusions Several salvage chemotherapy regimens demonstrate activity in high risk GTN. Multiple regimens may be required and cure is not universal.
KW - Chemotherapy
KW - Gestational trophoblastic neoplasia
KW - Placental site trophoblastic tumor
KW - Salvage
UR - http://www.scopus.com/inward/record.url?scp=85018992795&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85018992795&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2017.04.017
DO - 10.1016/j.ygyno.2017.04.017
M3 - Article
C2 - 28473205
AN - SCOPUS:85018992795
SN - 0090-8258
VL - 146
SP - 74
EP - 80
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 1
ER -