Page 63 - Test PDF v5

« Back to Contents MISCELLANEOUS

LiFE re

Literature for ENYGO

Gestational trophoblastic disease

Descriptive summary (cont.) Of the articles that met the inclusion criteria, one case report is
worthy of notice. Gonzalez Aguilera et al. described a patient with
found that primary remission rates were significantly higher among persistent low levels of serum hCG that did not respond to chemo-
patients treated with a 5-day drip infusion etoposide than with those therapy. After excluding disease persistence, the team decided to
treated with a 5-day intramuscular MTX regimen. Risk factors for analyse the levels of hCG in urine and in a HBT tube, revealing no
drug resistance were higher FIGO scores and pre-treatment human hCG in urine and the presence of phantom hCG due to heterophilic
chorionic gonadotropin (hCG) levels, as well as a <30 % decrease in mouse antibodies interaction. After doing a review of the literature,
hCG after the first cycles of MTX. they conclude that urinary hCG and/or a test for serum heterophilic
antibodies should be done when appropriate.
A third retrospective study by Peng compared tegafur plus actino-
mycin D (Act-D) vs. 5-FU plus Act-D in GTN. The complete response
rates in the tegafur and 5-Fu groups were 74.24 % and 76.59 %,
respectively, and the overall response rates were 90.63 % and
92.37 %, respectively. On the other hand, there was a significant
difference in the side effects in nausea, vomiting, dental ulcers, skin
lesions, and diarrhoea, favouring the tegafur group.

Finally, a Cochrane review was conducted on chemotherapy for
resistant and recurrent GTN. They establish that RCTs in GTN are
scarce. In case of MTX-resistant or recurrent low-risk GTN, 5-day
dactinomycin is usually used (which exhibits more side effects than
pulsed dactinomycin) , followed by MAC (methotrexate, dactinomy-
cin, cyclophosphamide) or EMA/CO (etoposide, methotrexate, dactin-
omycin, cyclophosphamide, vinblastine) if further salvage therapy
is required. For high-risk GTN, EMA/CO is the most commonly used
first-line therapy, with platinum-etoposide combinations, particu-
larly EMA/EP (etoposide, methotrexate, dactinomycin/etoposide,
cisplatin), being favoured as salvage therapy. Alternatives, including
TP/TE (paclitaxel, cisplatin/ paclitaxel, etoposide), BEP (bleomycin,
etoposide, cisplatin), FAEV (floxuridine, dactinomycin, etoposide,
vincristine), and FA (5-fluoruracil, dactinomycin), may be as effective
as EMA/EP and associated with fewer side effects. In all cases,
international RCT are needed to better establish ideal treatment.

Continued on the next page  Page 63

International Journal of Gynecological Cancer, Volume 26, Supplement #1