Management of drug resistant gestational trophoblastic neoplasia.
OBJECTIVE
To determine the outcome of secondary management in drug-resistant gestational trophoblastic neoplasia (GTN).


METHODS
Sixteen of 60 patients with GTN (8 low-risk and 8 high-risk) who developed resistance to primary chemotherapy were studied retrospectively. Primary chemotherapy was methotrexate-folinic acid rescue (MTX-FA) for low risk and etoposide/methotrexate/actinomycin D/cyclophosphamide/vincristine (EMA-CO) for high risk. Secondary chemotherapy for the low-risk group was either actinomycin D or EMA-CO, depending on serum beta human chorionic gonadotropin (hCG) levels at resistance. For the high-risk group, etoposide/methotrexate/actinomycin D/cisplatinum (EMA-EP) or bleomycin/etoposide/cisplatin (BEP) was given. Third-line chemotherapy was vincristine/actinomycin D/cyclophosphamide (VAC) or vincristine/ iphosphamide/cisplatin (VIP). Surgery and radiotherapy were used in selected patients.


RESULTS
Survival after salvage therapy in low-risk patients was 100%: 2 with EMA-CO and 6 with actinomycin D. Of high-risk cases 75% were cured with EMA-EP or BEP. Third-line chemotherapy was given in 2 patients: 1 was lost to follow-up and the other died. Survival was significantly influenced by both hCG level at the start of secondary therapy and site of metastasis.


CONCLUSIONS
Prognosis in GTN is excellent. Optimization of treatment strategies for those who develop drug resistance remains a key challenge.
Patel
Shilpa M
SM
Department of Gynecologic Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India. drshilpamukesh@gmail.com
Desai
Ava
A
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D002955:Leucovorin / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D009362:Neoplasm Metastasis; D011247:Pregnancy; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D014750:Vincristine / Q000008:administration & dosage
D018997:Chorionic Gonadotropin, beta Subunit, Human; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin; D002955:Leucovorin; D007069:Ifosfamide; D008727:Methotrexate