Botucatu Trophoblastic Disease Center, Botucatu Medical School Hospital, Department of Gynecology and Obstetrics, UNESP-Sao Paulo State University, Botucatu, SP, Brazil; Postgraduate Program in Tocogynecology of Botucatu Medical School, UNESP-São Paulo State University, Botucatu, SP, Brazil.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
Gynecol Oncol. 2020 May;157(2):372-378. doi: 10.1016/j.ygyno.2020.02.001. Epub 2020 Feb 7.
The purpose of this study was to evaluate both the outcomes and toxicity of second-line actinomycin D (ActD) chemotherapy in methotrexate (MTX) - resistant low-risk postmolar gestational trophoblastic neoplasia (GTN) with 5-day ActD versus pulsed ActD.
This retrospective cohort study included patients with MTX-resistant low-risk postmolar GTN from 1974 to 2016. Second-line chemotherapy consisted of 5-day ActD (10-12 μg/kg per day for 5 days every 14 days) or biweekly ActD (1.25 mg/m every 2 weeks). Data on patient characteristics, disease presentation, treatment outcome, and toxicity were collected.
Sixty-eight MTX-resistant patients receiving ActD as second-line chemotherapy were identified (5-day ActD, 53 patients; pulsed ActD, 15 patients). No significant differences were observed in patient/disease characteristics and sustained remission (overall rate 72%) between second-line ActD regimens. Time to hCG remission was significantly faster (median 21 vs 47 days, p = .04) and required fewer treatment cycles (median 1 vs 2, p < .001) with 5-day ActD. Thrombocytopenia was only observed with 5-day ActD (64.6 vs 0%, p < .001). The frequency (60.4 vs 16.7%, p = .009) and severity (grade 3: 37.9 vs 0%, p = .045) of oral mucositis was significantly higher with 5-day ActD. Grade 2 alopecia was significantly more frequent (70.6 vs 16.7%, p = .02) with 5-day ActD.
While 5-day ActD and pulsed ActD achieve comparable remission rates, due to its reduced toxicity, ease of administration, and patient convenience, pulsed ActD should be the treatment of choice for MTX-resistant postmolar low-risk GTN.
本研究旨在评估多柔比星（ActD）二线化疗在 5 天 ActD 与脉冲式 ActD 治疗 MTX 耐药低危绒癌中的疗效和毒性。
这项回顾性队列研究纳入了 1974 年至 2016 年期间 MTX 耐药低危绒癌患者。二线化疗包括 5 天 ActD（10-12μg/kg/天，每 14 天 5 天）或双周 ActD（1.25mg/m2，每 2 周）。收集了患者特征、疾病表现、治疗结果和毒性的数据。
共确定了 68 例接受 ActD 二线化疗的 MTX 耐药患者（5 天 ActD，53 例；脉冲式 ActD，15 例）。二线 ActD 方案之间患者/疾病特征和持续缓解率（总体缓解率为 72%）无显著差异。5 天 ActD 组 hCG 缓解时间更快（中位数 21 天 vs 47 天，p=0.04），所需治疗周期更少（中位数 1 个 vs 2 个，p<0.001）。5 天 ActD 组仅出现血小板减少（64.6% vs 0%，p<0.001）。5 天 ActD 组口腔黏膜炎的发生率（60.4% vs 16.7%，p=0.009）和严重程度（3 级：37.9% vs 0%，p=0.045）显著更高。5 天 ActD 组 2 级脱发更常见（70.6% vs 16.7%，p=0.02）。
虽然 5 天 ActD 和脉冲式 ActD 缓解率相当，但由于其毒性较低、给药方便和患者便利，脉冲式 ActD 应成为 MTX 耐药绒癌的首选治疗方法。
