Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
Department of Medical Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
Asia Pac J Clin Oncol. 2022 Jun;18(3):326-332. doi: 10.1111/ajco.13623. Epub 2021 Jun 29.
We aimed to compare weekly methotrexate (MTX) regimen and methotrexate-folinic acid (MTX-FA) 8-day regimen in the first line treatment of low-risk gestational trophoblastic neoplasia (GTN).
The study included 73 patients with low-risk GTN according to FIGO risk score (FIGO risk score < 7). All patients received either weekly MTX (30-50 mg/m intramuscular weekly) or MTX-FA 8-day (MTX 1 mg/kg IV on day 1, 3, 5, and 7, FA 15 mg orally on day 2, 4, 6, and 8 given 24 h after each MTX dose, every 14 days) regimens in the first-line treatment of low-risk GTN. The baseline clinicopathological characteristics and treatment outcomes were analyzed retrospectively.
The median age of all patients was 29 (18-51) years, and the median FIGO risk score was 3 (1-6). Of the patients recruited, 53 received MTX-FA 8-day, and 20 had MTX weekly regimens. There was a significant difference between the two groups with respect to FIGO risk scores (3 [1-6] vs. 2 [1-5], p = 0.023, MTX-FA 8-day vs. MTX weekly, respectively). The complete response rate was significantly higher in MTX-FA 8-day group compared to MTX weekly group (83% [44/53] vs. 60% [12/20] p = 0.038). In univariate and multivariate regression analyses, only presence of lung metastasis was found to be an independent risk factor for treatment resistance (OR: 3.959, 95% CI 1.105-14.179, p = 0.035).
MTX-FA 8-day regimen is more effective than weekly MTX regimen in the first line treatment of low-risk GTN including patients even with higher FIGO risk scores. Treatment resistance may develop especially in patients with lung metastasis.
本研究旨在比较每周甲氨蝶呤（MTX）方案与 MTX-亚叶酸（MTX-FA）8 天方案在低危妊娠滋养细胞肿瘤（GTN）一线治疗中的疗效。
本研究纳入了 73 例按照 FIGO 危险评分（FIGO 评分<7）诊断为低危 GTN 的患者。所有患者均接受每周 MTX（30-50mg/m 肌肉注射，每周一次）或 MTX-FA 8 天方案（第 1、3、5 和 7 天 MTX 1mg/kg 静脉注射，第 2、4、6 和 8 天 MTX 剂量后 24 小时给予 FA 15mg 口服，每 14 天一次）一线治疗。回顾性分析了患者的基线临床病理特征和治疗结局。
所有患者的中位年龄为 29（18-51）岁，中位 FIGO 评分均为 3（1-6）。入组患者中，53 例接受 MTX-FA 8 天方案，20 例接受 MTX 每周方案。两组患者的 FIGO 评分存在显著差异（3[1-6]与 2[1-5]，p=0.023，MTX-FA 8 天方案与 MTX 每周方案）。MTX-FA 8 天方案组的完全缓解率明显高于 MTX 每周方案组（83%[44/53]与 60%[12/20]，p=0.038）。单因素和多因素回归分析显示，仅存在肺转移是治疗耐药的独立危险因素（OR：3.959，95%CI 1.105-14.179，p=0.035）。
MTX-FA 8 天方案较每周 MTX 方案治疗低危 GTN 更有效，包括 FIGO 评分较高的患者。肺转移患者可能更容易发生耐药。
