Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Asian Pac J Cancer Prev. 2020 Nov 1;21(11):3325-3329. doi: 10.31557/APJCP.2020.21.11.3325.
Low-risk gestational trophoblastic neoplasia (GTN) is generally treated with single agent chemotherapy and methotrexate (MTX) as a first-line therapy. Vitamin A helps to increase trophoblast cell regression, as well as to decrease β-hCG levels. Vitamin A also increases the effectiveness of MTX by inducing more malignant cell death than MTX alone. Therefore, the aim of the current study was to analyze the changes in β-hCG levels in low-risk GTN patients following vitamin A administration.
This study was a randomized clinical trial, which examined initial serum vitamin A and β-hCG levels in GTN patients before and after three cycles of MTX therapy. Patients were given vitamin A supplementation of 6,000 IU (1.8 mg RAEs) per day, and the changes in serum β-hCG were observed after three cycles. Patients were grouped by β-hCG levels (decreased or stagnant).
A total of 32 low-risks GTN patients were divided into the intervention group (16 patients who received vitamin A supplementation) and the control group (16 patients who did not receive vitamin A supplementation). In the intervention group, the average initial β-hCG level was 170,949.3 ± 354,452.1 mIU/mL, and the average β-hCG post-cycle level was 1,611.9 ± 3,652.5 mIU/mL. In the control group, the average initial β-hCG level was 178,834.1 ± 2913844.6 mIU/mL, and the average β-hCG post-cycle level was 25,388.5 ± 58,437.7 mIU/mL.
In patients with low-risk GTN who underwent MTX chemotherapy, the levels of β-hCG and the incidence of chemo resistance in the intervention group were lower than those in the control group. Older age may also influence the incidence of chemo resistance in GTN patients. Oral administration of 6,000 IU vitamin A could help to reduce β-hCG levels in low-risk GTN patients who receive MTX chemotherapy.
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低危型妊娠滋养细胞肿瘤（GTN）一般采用单一药物化疗，甲氨蝶呤（MTX）作为一线治疗药物。维生素 A 有助于促进滋养细胞的退化，降低β-hCG 水平。维生素 A 还通过诱导比 MTX 单独作用更多的恶性细胞死亡来提高 MTX 的疗效。因此，本研究旨在分析低危型 GTN 患者接受维生素 A 治疗后β-hCG 水平的变化。
本研究为随机临床试验，观察了 GTN 患者在 MTX 治疗三个周期前后的初始血清维生素 A 和β-hCG 水平。患者每天给予 6000IU（1.8mgRAEs）维生素 A 补充剂，并在三个周期后观察血清β-hCG 的变化。根据β-hCG 水平（降低或停滞）将患者分为两组。
共纳入 32 例低危型 GTN 患者，分为干预组（16 例接受维生素 A 补充）和对照组（16 例未接受维生素 A 补充）。干预组患者的初始β-hCG 水平平均为 170949.3±354452.1mIU/mL，治疗后平均β-hCG 水平为 1611.9±3652.5mIU/mL。对照组患者的初始β-hCG 水平平均为 178834.1±2913844.6mIU/mL，治疗后平均β-hCG 水平为 25388.5±58437.7mIU/mL。
在接受 MTX 化疗的低危型 GTN 患者中，干预组的β-hCG 水平和化疗耐药发生率低于对照组。年龄较大也可能影响 GTN 患者的化疗耐药发生率。口服 6000IU 维生素 A 可能有助于降低接受 MTX 化疗的低危型 GTN 患者的β-hCG 水平。
