Low-risk gestational trophoblastic neoplasia and methotrexate resistance: predictors of response to treatment with actinomycin D and need for combination chemotherapy.
OBJECTIVE
To determine whether any clinical parameters predict the need for multiagent chemotherapy for treatment of low-risk gestational trophoblastic neoplasia (GTN) after the development of methotrexate (MTX) resistance.


METHODS
We retrospectively analyzed clinical data from the New England Trophoblastic Disease Center from women with post-molar GTN between 1973 and 2003.


RESULTS
We analyzed data from 150 women (40 with partial mole, 110 with complete mole) who received single-agent MTX for low-risk GTN using FIGO and WHO scoring systems. Of the 45 women who developed MTX resistance, the majority (37/45) of these patients received actinomycin D, with 10 patients ultimately requiring multiagent chemotherapy. The requirement for multiagent chemotherapy following MTX resistance was associated with a beta-hCG > 600 mlU/mL 1 week following initial MTX therapy (p < 0.03). Conversely, a beta-hCG < 600 mlU/mL 1 week following initial MTX therapy was as-sociated with a 93% probability of remission with actinomycin D alone. All patients went into durable remission.


CONCLUSIONS
The prognosis for patients with low-risk GTN following molar gestation is excellent, with 100% remission rate, though a small but significant proportion (7%) required multiagent chemotherapy. The need for multiagent chemotherapy was associated with beta-hCG levels 1 week following initial MTX therapy.
Growdon
Whitfield B
WB
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, USA.
Wolfberg
Adam J
AJ
Goldstein
Donald P
DP
Feltmate
Colleen M
CM
Chinchilla
Manuel E
ME
Lieberman
Ellice S
ES
Berkowitz
Ross S
RS
D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000008:administration & dosage / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011247:Pregnancy; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000473:pathology
D000964:Antimetabolites, Antineoplastic; D018997:Chorionic Gonadotropin, beta Subunit, Human; D003609:Dactinomycin; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate