Salvage combination chemotherapy with floxuridine, dactinomycin, etoposide, and vincristine (FAEV) for patients with relapsed/chemoresistant gestational trophoblastic neoplasia.
BACKGROUND
Although most patients with gestational trophoblastic neoplasia (GTN) are cured by conventional chemotherapy, some develop drug resistance or relapse. The use of new combination drugs has been studied to treat those with resistant or relapsed disease. We evaluated the results of floxuridine, dactinomycin, etoposide, and vincristine (FAEV) chemotherapy in patients with relapsed/chemoresistant GTN.


METHODS
Clinical data and outcome of the patients with relapsed/chemoresistant GTN from 1 January 2005 to 30 June 2008 were retrospectively reviewed. Eligible patients had received at least one cycle of FAEV chemotherapy. The primary end points were response rate and toxicity of FAEV regimen; the secondary end point was assessment of clinical predictors of response.


RESULTS
In total, 91 patients were included. Fifty-five of these patients (60.4%) achieved serologic complete remission (SCR), 29 patients had no response, 7 patients experienced recurrent grade ≥3 or intolerable toxicity. SCR of FAEV chemotherapy was significantly associated with number of previous chemotherapy regimens (≤2) in multivariate analysis (P = 0.005). The most serious adverse events were greater than or equal to grade 3 neutropenia (26.4%), febrile neutropenia (6.6%), and greater than or equal to grade 3 thrombocytopenia (3.3%).


CONCLUSIONS
FAEV is an effective regimen with manageable toxicity for patients with relapsed/chemoresistant GTN. Further studies of this regimen are warranted.
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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F
Feng
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. Electronic address: xiangyang65@gmail.com.
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Y
Xiang
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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X
Wan
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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S
Geng
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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T
Wang
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D003609:Dactinomycin / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm / Q000187:drug effects*; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary; D008207:Lymphatic Metastasis; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy* / Q000473:pathology; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
D005467:Floxuridine; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide