Serum hCG level and rising world health organization score at second-line chemotherapy (pulse dactinomycin): poor prognostic factors for methotrexate-failed low-risk gestational trophoblastic neoplasia.
BACKGROUND
The aim of this study was to determine the factors associated with failure in patients receiving pulse dactinomycin as second-line chemotherapy for low-risk gestational trophoblastic neoplasia (GTN) according to the revised International Federation of Obstetrics and Gynecology 2000 scoring system at a single institution.


METHODS
Between January 1997 and June 2007, 37 patients with methotrexate-failed low-risk GTN were treated with pulse dactinomycin (1.25 mg/m intravenously every 2 weeks). All patients had low-risk GTN based on the revised International Federation of Obstetrics and Gynecology 2000 scoring system at the time of second-line chemotherapy. A logistic regression model was used to analyze the relationship between covariates and treatment failure.


RESULTS
There were 28 (75.7%) patients who achieved primary remission with pulse dactinomycin. All 9 treatment failures achieved complete remission after receiving subsequent chemotherapy; 1 patient also underwent hysterectomy. Patients successfully treated with pulse dactinomycin required a median of 4.0 cycles (range, 2-7) to achieve a complete response. The risk of failure with pulse dactinomycin was higher for serum hCG levels 10 or higher when initiating pulse dactinomycin (odds ratio, 8.91; 95% confidence interval, 1.08-73.53) and a rising World Health Organization score of 2 or higher after first-line chemotherapy (odds ratio, 12.59; 95% confidence interval, 1.60-99.25). With respect to the previous methotrexate regimen and cause of failed methotrexate chemotherapy, there were no differences between those who were successfully treated and those who failed pulse dactinomycin.


CONCLUSIONS
Serum hCG level and a rising World Health Organization score at the time of initiating pulse dactinomycin are important prognostic factors in patients with methotrexate-failed low-risk GTN receiving pulse actinomycin as second-line chemotherapy.
Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea.
Woo Dae
WD
Kang
Cheol Hong
CH
Kim
Moon Kyoung
MK
Cho
Jong Woon
JW
Kim
Hye Yon
HY
Cho
Yoon Ha
YH
Kim
Ho Sun
HS
Choi
Seok Mo
SM
Kim
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D054316:Biomarkers, Pharmacological / Q000032:analysis / Q000097:blood; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood; D017024:Chemotherapy, Adjuvant; D006063:Chorionic Gonadotropin / Q000097:blood*; D003609:Dactinomycin / Q000008:administration & dosage*; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D011379:Prognosis; D020551:Pulse Therapy, Drug; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D015854:Up-Regulation; D014944:World Health Organization; D055815:Young Adult
D000903:Antibiotics, Antineoplastic; D054316:Biomarkers, Pharmacological; D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D008727:Methotrexate