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Traboulsi W, Reynaud D, Abi Nahed R, Sergent F, Alfaidy N, Benharouga M. In Vivo Quantitative Assessment of Gestational Choriocarcinoma Development and Progression Using Luminescent Trophoblast Cells. Methods Mol Biol 2024; 2728:77-85. [PMID: 38019392 DOI: 10.1007/978-1-0716-3495-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Gestational trophoblastic diseases (GTD) are a group of pregnancy-related disorders representing rare human tumors. Among GTD is the gestational choriocarcinoma (CC), which is a highly malignant gestational trophoblastic tumor that causes high mortality without timely treatment. The incidence of CC is about 1 in 50,000 pregnancies in developed countries and even higher in developing countries. CC developed from molar pregnancies exhibits even higher incidence rates (3-20 in 1000 pregnancies). In the present invention, we developed the first orthotopic animal model of CC. We demonstrate how to mimic the development of this cancer and observe rapid metastasis, which is seen in CC patients, by injecting the luciferase-positive JEG-3 (JEG-3-Luc) cells directly in the placenta of gravid SCID mice. Gravid mice were injected at 7.5 days post coitus (dpc) and followed throughout gestation to assess the parameters of CC development and metastasis. Mice imaged at day 19.5 dpc showed placental tumor development and large sites of metastases in the liver, spleen, lung, and peritoneum. This finding emphasizes the importance of placental vascularization in the rapid dissemination of tumor cells. Morphological analyses and histopathological examinations were performed to confirm JEG-3 cell dissemination in different organs of the gravid mice. This is the first time a CC model was developed by injection of tumor cells within the placenta. This technique offers a new tool to study tumor progression with strong perspectives to test anti-tumor agents in vivo.
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Affiliation(s)
- Wael Traboulsi
- Lombardi Comprehensive Cancer Center, Laboratory for Immuno-Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Deborah Reynaud
- Institut National de la Santé et de la Recherche Médicale, Inserm U1292, Grenoble, France
- University Grenoble-Alpes, Grenoble, France
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Roland Abi Nahed
- Institut National de la Santé et de la Recherche Médicale, Inserm U1292, Grenoble, France
- University Grenoble-Alpes, Grenoble, France
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Frédéric Sergent
- Institut National de la Santé et de la Recherche Médicale, Inserm U1292, Grenoble, France
- University Grenoble-Alpes, Grenoble, France
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Nadia Alfaidy
- Institut National de la Santé et de la Recherche Médicale, Inserm U1292, Grenoble, France.
- University Grenoble-Alpes, Grenoble, France.
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France.
| | - Mohamed Benharouga
- Institut National de la Santé et de la Recherche Médicale, Inserm U1292, Grenoble, France
- University Grenoble-Alpes, Grenoble, France
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
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Korkmaz V, Sunar V, Akar S, Alinca CM, Arik Z, Boran N, Ozdal B, Ustun YE. Comparison of weekly methotrexate regimen versus methotrexate folinic acid 8-day regimen for treatment of low-risk gestational trophoblastic neoplasia. Asia Pac J Clin Oncol 2021; 18:326-332. [PMID: 34185962 DOI: 10.1111/ajco.13623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
AIM 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). METHODS 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/m2 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Vakkas Korkmaz
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Veli Sunar
- Department of Medical Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Serra Akar
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cihat Murat Alinca
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Nurettin Boran
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Bülent Ozdal
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yaprak Engin Ustun
- Department of Gynecology and Obstetrics, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Tu X, Chen R, Huang G, Lu N, Chen Q, Bai X, Li B. Factors Predicting Severe Myelosuppression and Its Influence on Fertility in Patients with Low-Risk Gestational Trophoblastic Neoplasia Receiving Single-Agent Methotrexate Chemotherapy. Cancer Manag Res 2020; 12:4107-4116. [PMID: 32581584 PMCID: PMC7276201 DOI: 10.2147/cmar.s252664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the potential factors to predict severe myelosuppression among low-risk gestational trophoblastic neoplasia (GTN) patients with single-agent methotrexate (MTX) chemotherapy. To analyze reproductive outcomes of patients with or without severe myelosuppression after achieving complete remission (CR). Patients and Methods The retrospective study included 319 low-risk GTN patients registered from January 2008 to December 2018 in our hospital. Patients were divided into two groups according to myelosuppression grading. Their clinical data and reproductive outcomes were compared and analyzed. Results A higher proportion of patients in group A received second-line chemotherapy than group B (P<0.001). The number of total chemotherapy courses was more in group A than group B (P=0.001), while the number of MTX chemotherapy courses was more in group B than group A (P=0.001). When the joint predictor of pretreatment albumin (ALB) was not more than 44.5 g/L, pretreatment serum creatinine (Scr) was not less than 75.6 μmol/L, and the number of MTX chemotherapy courses was not less than four, there was a moderate predictive value. There was no significant difference of reproductive outcomes between the two groups after achieving CR. Conclusion Although some patients developed severe myelosuppression, MTX was still the effective first-line treatment for low-risk GTN patients. Patient’s pretreatment ALB was not more than 44.5 g/L, pretreatment Scr was not less than 75.6 μmol/L, and the number of MTX chemotherapy courses not less than four could be used as combined predictors to recognize the risk of severe myelosuppression. Severe myelosuppression had no significant adverse influence on fertility after achieving CR.
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Affiliation(s)
- Xiaoyu Tu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Ruizhe Chen
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Genping Huang
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Nanjia Lu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Qin Chen
- Department of Pathology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Xiaoxia Bai
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Baohua Li
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
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Rizvi SAA, Shahzad Y, Saleh AM, Muhammad N. Dose Issues in Cancer Chemotherapy. Oncology 2020; 98:520-527. [PMID: 32369814 DOI: 10.1159/000506705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/19/2020] [Indexed: 11/19/2022]
Abstract
In this review, human methotrexate dosing regimens, as well as their relationship to data from in vitro cell culture and in vivo animal and human studies, are discussed. Low-dose, intermediate-dose, and high-dose therapies are covered. Since in vitro and in vivo screenings of potential cancer drugs are commonplace in the development of cancer chemotherapy, comparisons of the three criteria for effectiveness are important.
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Affiliation(s)
- Syed A A Rizvi
- Department of Pharmaceutical Sciences, Hampton University School of Pharmacy, Hampton, Virginia, USA,
| | - Yasser Shahzad
- Department of Pharmacy, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
| | - Ayman M Saleh
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, and King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | - Nawshad Muhammad
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
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Huang B, Zhu W, Chang J, Dai X, Yu G, Huang C, Wang E, Li Z, Lin L, Wang B, Chen J, Xiao T, Niu J, Zhang J. Role of G protein-coupled receptor 1 in choriocarcinoma progression. Am J Physiol Cell Physiol 2019; 317:C556-C565. [PMID: 31241986 DOI: 10.1152/ajpcell.00059.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Choriocarcinoma is characterized by malignant proliferation and transformation of trophoblasts and is currently treated with systemic chemotherapeutic agents. The lack of specific targets for chemotherapeutic agents results in indiscriminate drug distribution. In our study, we aimed to delineate the mechanism by which G protein-coupled receptor 1 (GPR1) regulates the development of choriocarcinoma and thus investigated GPR1 as a prospective chemotherapeutic target. In this study, GPR1 expression levels were examined in several trophoblast cell lines. We found significantly higher GPR1 expression in choriocarcinoma cells (JEG3 and BeWo) than in normal trophoblast cells (HTR-8/SVneo). Additionally, we studied the role of GPR1 in choriocarcinoma in vitro and in vivo. GPR1 knockdown suppressed proliferation, invasion, and Akt and ERK phosphorylation in vitro and slowed tumor growth in vivo. Interestingly, GPR1 overexpression promoted increased proliferation, invasion, and Akt and ERK phosphorylation in vitro. Furthermore, we identified a specific GPR1-binding seven-amino acid peptide, LRH7-G3, that might also suppress choriocarcinoma in vitro and in vivo through phage display. Our study is the first to report that GPR1 may play a role in regulating choriocarcinoma progression through the Akt and ERK pathways. GPR1 could be a promising potential pharmaceutical target for choriocarcinoma.
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Affiliation(s)
- Binbin Huang
- Center for Reproduction and Health Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Wen Zhu
- Center for Reproduction and Health Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Junlei Chang
- Center for Antibody Drug, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiaoyong Dai
- Center for Reproduction and Health Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Guiyuan Yu
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Chen Huang
- Center for Reproduction and Health Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Esther Wang
- Biological Sciences Collegiate Division, University of Chicago, Chicago, Illinois
| | - Zhihuan Li
- Dongguan Enlife Stem Cell Biotechnology Institute, Dongguan, China
| | - Lilong Lin
- Dongguan Enlife Stem Cell Biotechnology Institute, Dongguan, China
| | - Baobei Wang
- Center for Reproduction and Health Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jie Chen
- Center for Reproduction and Health Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Tianxia Xiao
- Center for Reproduction and Health Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jianmin Niu
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jian Zhang
- Center for Reproduction and Health Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
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Kanno T, Matsui H, Akizawa Y, Usui H, Shozu M. Treatment results of the second-line chemotherapy regimen for patients with low-risk gestational trophoblastic neoplasia treated with 5-day methotrexate and 5-day etoposide. J Gynecol Oncol 2019; 29:e89. [PMID: 30207097 PMCID: PMC6189429 DOI: 10.3802/jgo.2018.29.e89] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Highly effective chemotherapy for patients with low-risk gestational trophoblastic neoplasia (GTN) is associated with almost a 100% cure rate. However, 20%–30% of patients treated with chemotherapy need to change their regimens due to severe adverse events (SAEs) or drug resistance. We examined the treatment outcomes of second-line chemotherapy for patients with low-risk GTN. Methods Between 1980 and 2015, 281 patients with low-risk GTN were treated. Of these 281 patients, 178 patients were primarily treated with 5-day intramuscular methotrexate (MTX; n=114) or 5-day drip infusion etoposide (ETP; n=64). We examined the remission rates, the drug change rates, and the outcomes of second-line chemotherapy. Results The primary remission rates and drug resistant rates of 5-day ETP were significantly higher (p<0.001) and significantly lower (p=0.002) than those of 5-day MTX, respectively. Forty-seven patients (26.4%) required a change in their chemotherapy regimen due to the SAEs (n=16) and drug resistance (n=31), respectively. Of these 47 patients failed the first-line regimen, 39 patients (39/47, 82.9%) were re-treated with single-agent chemotherapy, and 35 patients (35/39, 89.7%) achieved remission. Four patients failed second-line, single-agent chemotherapy and eight patients (17.0%) who failed first-line regimens were treated with combined or multi-agent chemotherapy and achieved remission. Conclusions Patients with low-risk GTN were usually treated with single-agent chemotherapy, while 20%–30% patients had to change their chemotherapy regimen due to SAEs or drug resistance. The second-line regimens of single-agent chemotherapy were effective; however, there were several patients who needed multiple agents and combined chemotherapy to achieve remission.
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Affiliation(s)
- Toshiyuki Kanno
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideo Matsui
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yoshika Akizawa
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirokazu Usui
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Mangili G, Cioffi R, Danese S, Frigerio L, Ferrandina G, Cormio G, Rabaiotti E, Scarfone G, Gadducci A, Bergamini A, Pisano C, Candiani M. Does methotrexate (MTX) dosing in a 8-day MTX/FA regimen for the treatment of low-risk gestational trophoblastic neoplasia affect outcomes? The MITO-9 study. Gynecol Oncol 2018; 151:449-452. [PMID: 30266260 DOI: 10.1016/j.ygyno.2018.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/15/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare clinical outcomes of patients diagnosed with low-risk gestational trophoblastic neoplasia (GTN) receiving intramuscular methotrexate 50 mg total dose/day versus 1 mg/kg/day in a 8-day methotrexate/folinic acid (MTX/FA) regimen. METHODS This retrospective, multicenter study included 176 patients: 99 (56%) receiving methotrexate 50 mg total dose/day on days 1, 3, 5, 7 alternated with FA 7,5 mg on days 2, 4, 6, 8, every 14 days (group A); and 77 patients (44%), receiving methotrexate 1 mg/kg/day on days 1, 3, 5, 7 alternated with FA 7,5 mg on days 2, 4, 6, 8, every 14 days (group B). Patients' characteristics and outcomes were compared by univariate analysis. RESULTS Forty-five patients (25.6%) developed resistance to MTX and received a second-line treatment, 7 (4%) received a third-line treatment and 8 (4.5%) relapsed after initial remission. There was no difference between group A and B patients in the average number of chemotherapy cycles required to achieve remission (5.7 ± 2.6 vs 6.3 ± 2.3, p = 0.106). The 2 treatment groups showed comparable rates of MTX resistance (28.3% vs 22.1%, p = 0.387) and relapse (3% vs 6.5%, p = 0.300). There was no difference in the incidence of treatment toxicity of any CTCAE grade between group A and B patients (16.2% vs 15.2%, p = 0.999). Subgroup analysis stratifying patients by weight (<50 kg, ≥60 kg, ≥70 kg, ≥80 kg) confirmed these results. CONCLUSION The 2 MTX schedules showed comparable efficacy in the treatment of low-risk GTN with an acceptable rate of toxicity.
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Affiliation(s)
- Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Saverio Danese
- Obstetrics and Gynecology Unit, Ospedale S. Anna, Turin, Italy
| | - Luigi Frigerio
- Obstetrics and Gynecology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Istituto Tumori "Giovanni Paolo II", University of Bari, Italy
| | - Emanuela Rabaiotti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Scarfone
- Obstetrics and Gynecology Unit, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Angiolo Gadducci
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmela Pisano
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Mu X, Song L, Li Q, Yin R, Zhao X, Wang D. Comparison of pulsed actinomycin D and 5-day actinomycin D as first-line chemotherapy for low-risk gestational trophoblastic neoplasia. Int J Gynaecol Obstet 2018; 143:225-231. [PMID: 30051913 DOI: 10.1002/ijgo.12629] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/09/2018] [Accepted: 07/25/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Xiyan Mu
- Department of Obstetrics and Gynecology; West China Second Hospital of Sichuan University; Chengdu China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University); Ministry of Education; Chengdu China
| | - Liang Song
- Department of Obstetrics and Gynecology; West China Second Hospital of Sichuan University; Chengdu China
| | - Qingli Li
- Department of Obstetrics and Gynecology; West China Second Hospital of Sichuan University; Chengdu China
| | - Rutie Yin
- Department of Obstetrics and Gynecology; West China Second Hospital of Sichuan University; Chengdu China
| | - Xia Zhao
- Department of Obstetrics and Gynecology; West China Second Hospital of Sichuan University; Chengdu China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University); Ministry of Education; Chengdu China
| | - Danqing Wang
- Department of Obstetrics and Gynecology; West China Second Hospital of Sichuan University; Chengdu China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University); Ministry of Education; Chengdu China
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First-line hysterectomy for women with low-risk non-metastatic gestational trophoblastic neoplasia no longer wishing to conceive. Gynecol Oncol 2018; 150:282-287. [DOI: 10.1016/j.ygyno.2018.05.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 11/18/2022]
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10
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Li J, Li S, Yu H, Wang J, Xu C, Lu X. The efficacy and safety of first-line single-agent chemotherapy regimens in low-risk gestational trophoblastic neoplasia: A network meta-analysis. Gynecol Oncol 2017; 148:247-253. [PMID: 29203174 DOI: 10.1016/j.ygyno.2017.11.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is no consensus regarding what should be the optimal single-agent regimen in low-risk gestational trophoblastic neoplasia(LRGTN). we performed this network meta-analysis(NMA) and our aim is to synthesize all efficacy evidence, enabling a comparison of all single-agent methotrexate(MTX)-based or actinomycin-d(Act-D)-based regimens in LRGTN. METHODS We performed a literature search of PubMed, Embase, and the Cochrane Library for all relevant articles. Seven randomized controlled trials and four retrospective studies met the study eligibility criteria. Overall, 987 patients were included. Treatments were grouped into weekly intramuscular MTX(w-IM MTX), five-day intramuscular MTX(5d-IM MTX), five-day intravenous MTX(5d-IV MTX), eight-day intramuscular MTX with folinic acid(MTX-FA), five-day intravenous Act-D(5d-IV Act-D), and bi-weekly pulsed intravenous Act-D (pulsed IV Act-D) treatments. P-score was used to rank the treatments. RESULTS Values of P-score indicated that the Act-D-based regimens had superior efficacy compared with the MTX-based regimens. Namely, 5d-IV Act-D had the highest probability of being the best treatment arm for CR, followed by pulsed IV Act-D and 5d-IV MTX. Similar results were observed in the subgroup analysis from the prospective studies. Toxicity analysis indicated that 5d-IM MTX showed increased toxicity in nausea and vomiting, as measured by their P-scores. In contrast, 5d-IV Act-D had the highest probability of being the least toxic regimen in terms of nausea and vomiting. Grade 3/4 adverse events (AEs), though infrequent, were more frequently observed in 5d-IM MTX, followed by 5d-IV Act-D and 5d-IV MTX. CONCLUSIONS Our NMA provides a systematic evaluation of the relative efficacy of available single-agent MTX-based and Act-D-based regimes in LRGTN. Until new evidence becomes available, 5d-IV Act-D and pulsed IV Act-D appear to be the best treatment options in LRGTN.
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Affiliation(s)
- Jun Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Shufen Li
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Rd., Shanghai, China
| | - Hinlin Yu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Jieyu Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Congjian Xu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Xin Lu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China.
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Traboulsi W, Sergent F, Boufettal H, Brouillet S, Slim R, Hoffmann P, Benlahfid M, Zhou QY, Balboni G, Onnis V, Bolze PA, Salomon A, Sauthier P, Mallet F, Aboussaouira T, Feige JJ, Benharouga M, Alfaidy N. Antagonism of EG-VEGF Receptors as Targeted Therapy for Choriocarcinoma Progression In Vitro and In Vivo. Clin Cancer Res 2017; 23:7130-7140. [PMID: 28899975 DOI: 10.1158/1078-0432.ccr-17-0811] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/26/2017] [Accepted: 08/31/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Choriocarcinoma (CC) is the most malignant gestational trophoblastic disease that often develops from complete hydatidiform moles (CHM). Neither the mechanism of CC development nor its progression is yet characterized. We recently identified endocrine gland-derived vascular endothelial growth factor (EG-VEGF) as a novel key placental growth factor that controls trophoblast proliferation and invasion. EG-VEGF acts via two receptors, PROKR1 and PROKR2. Here, we demonstrate that EG-VEGF receptors can be targeted for CC therapy.Experimental Design: Three approaches were used: (i) a clinical investigation comparing circulating EG-VEGF in control (n = 20) and in distinctive CHM (n = 38) and CC (n = 9) cohorts, (ii) an in vitro study investigating EG-VEGF effects on the CC cell line JEG3, and (iii) an in vivo study including the development of a novel CC mouse model, through a direct injection of JEG3-luciferase into the placenta of gravid SCID-mice.Results: Both placental and circulating EG-VEGF levels were increased in CHM and CC (×5) patients. EG-VEGF increased JEG3 proliferation, migration, and invasion in two-dimensional (2D) and three-dimensional (3D) culture systems. JEG3 injection in the placenta caused CC development with large metastases compared with their injection into the uterine horn. Treatment of the animal model with EG-VEGF receptor's antagonists significantly reduced tumor development and progression and preserved pregnancy. Antibody-array and immunohistological analyses further deciphered the mechanism of the antagonist's actions.Conclusions: Our work describes a novel preclinical animal model of CC and presents evidence that EG-VEGF receptors can be targeted for CC therapy. This may provide safe and less toxic therapeutic options compared with the currently used multi-agent chemotherapies. Clin Cancer Res; 23(22); 7130-40. ©2017 AACR.
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Affiliation(s)
- Wael Traboulsi
- Institut National de la Santé et de la Recherche Médicale, Unité Grenoble, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Frédéric Sergent
- Institut National de la Santé et de la Recherche Médicale, Unité Grenoble, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Houssine Boufettal
- Faculty of Medicine and Pharmacy, University Hassan II Casablanca and Ibn Rochd Hospital of Casablanca, Obstetrics and Gynecology Department, Casablanca, Morocco
| | - Sophie Brouillet
- Institut National de la Santé et de la Recherche Médicale, Unité Grenoble, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France.,University Hospital of Grenoble, Department of Obstetrics and Gynaecology, and Laboratoire d'Aide à la Procréation-CECOS, La Tronche, France
| | - Rima Slim
- Department of Human Genetics, McGill University Health Centre Research Institute, Montréal, Quebec, Canada
| | - Pascale Hoffmann
- Institut National de la Santé et de la Recherche Médicale, Unité Grenoble, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France.,University Hospital of Grenoble, Department of Obstetrics and Gynaecology, and Laboratoire d'Aide à la Procréation-CECOS, La Tronche, France
| | - Mohammed Benlahfid
- Faculty of Medicine and Pharmacy, University Hassan II Casablanca and Ibn Rochd Hospital of Casablanca, Obstetrics and Gynecology Department, Casablanca, Morocco
| | - Qun Y Zhou
- Department of Pharmacology, University of California, Irvine, California
| | - Gianfranco Balboni
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Valentina Onnis
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Pierre A Bolze
- University of Lyon 1, University Hospital Lyon Sud, Department of Gynecological Surgery and Oncology, Obstetrics, Lyon, France.,French Reference Center for Gestational Trophoblastic Diseases, University Hospital Lyon Sud, Chemin du Grand Revoyet, Pierre Bénite, Lyon, France.,Joint Unit Hospices Civils de Lyon-bioMerieux, Cancer Biomarkers Research Group, University Hospital Lyon Sud, Lyon, France
| | - Aude Salomon
- Institut National de la Santé et de la Recherche Médicale, Unité Grenoble, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Philippe Sauthier
- Department of Human Genetics, McGill University Health Centre Research Institute, Montréal, Quebec, Canada
| | - François Mallet
- Joint Unit Hospices Civils de Lyon-bioMerieux, Cancer Biomarkers Research Group, University Hospital Lyon Sud, Lyon, France.,EA 7426 Pathophysiology of Injury-induced Immunosuppression, University of Lyon 1 Hospices Civils de Lyon bioMérieux, Hôpital Edouard Herriot, Lyon, France
| | - Touria Aboussaouira
- Faculty of Medicine and Pharmacy, University Hassan II Casablanca and Ibn Rochd Hospital of Casablanca, Obstetrics and Gynecology Department, Casablanca, Morocco
| | - Jean J Feige
- Institut National de la Santé et de la Recherche Médicale, Unité Grenoble, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Mohamed Benharouga
- University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche, Laboratoire de Chimie et Biologie des Métaux, Grenoble, France
| | - Nadia Alfaidy
- Institut National de la Santé et de la Recherche Médicale, Unité Grenoble, Grenoble, France. .,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
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Validation of the Predictive Value of Modeled Human Chorionic Gonadotrophin Residual Production in Low-Risk Gestational Trophoblastic Neoplasia Patients Treated in NRG Oncology/Gynecologic Oncology Group-174 Phase III Trial. Int J Gynecol Cancer 2016; 26:208-15. [PMID: 26569059 DOI: 10.1097/igc.0000000000000581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In low-risk gestational trophoblastic neoplasia, chemotherapy effect is monitored and adjusted with serum human chorionic gonadotrophin (hCG) levels. Mathematical modeling of hCG kinetics may allow prediction of methotrexate (MTX) resistance, with production parameter "hCGres." This approach was evaluated using the GOG-174 (NRG Oncology/Gynecologic Oncology Group-174) trial database, in which weekly MTX (arm 1) was compared with dactinomycin (arm 2). METHODS Database (210 patients, including 78 with resistance) was split into 2 sets. A 126-patient training set was initially used to estimate model parameters. Patient hCG kinetics from days 7 to 45 were fit to: [hCG(time)] = hCG7 * exp(-k * time) + hCGres, where hCGres is residual hCG tumor production, hCG7 is the initial hCG level, and k is the elimination rate constant. Receiver operating characteristic (ROC) analyses defined putative hCGRes predictor of resistance. An 84-patient test set was used to assess prediction validity. RESULTS The hCGres was predictive of outcome in both arms, with no impact of treatment arm on unexplained variability of kinetic parameter estimates. The best hCGres cutoffs to discriminate resistant versus sensitive patients were 7.7 and 74.0 IU/L in arms 1 and 2, respectively. By combining them, 2 predictive groups were defined (ROC area under the curve, 0.82; sensitivity, 93.8%; specificity, 70.5%). The predictive value of hCGres-based groups regarding resistance was reproducible in test set (ROC area under the curve, 0.81; sensitivity, 88.9%; specificity, 73.1%). Both hCGres and treatment arm were associated with resistance by logistic regression analysis. CONCLUSIONS The early predictive value of the modeled kinetic parameter hCGres regarding resistance seems promising in the GOG-174 study. This is the second positive evaluation of this approach. Prospective validation is warranted.
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13
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Wang Y, Miao JW, Wang T, Wang Y, Wu YM, Kong WM, Su L, Duan W. Comparison of MACT and 5Fu+ACT-D chemotherapy regimens in the treatment of low-risk gestational trophoblastic neoplasia. J Chemother 2016; 28:135-9. [PMID: 27105436 DOI: 10.1080/1120009x.2015.1136778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The study aimed to compare the efficacy of methotrexate (MTX) cervical injections + actinomycin-D (ACT-D)(MACT) and 5-fluorouracil (5-Fu) + actinomycin-D (5-Fu plus ACT-D) chemotherapy regimens for low-risk gestational trophoblastic neoplasia (LR-GTN). Clinical data from 66 LR-GTN patients, admitted to the Beijing Obstetrics and Gynecology Hospital from January 2010 to April 2012, were analysed retrospectively. In total, 32 patients were treated with a MACT therapeutic regimen and the remaining 34 with a 5Fu + ACT-D therapeutic regimen. Complete remission rates (CR), duration of treatment, hospital stay and toxicity effects were compared. There was no statistical difference in CR for the MACT (90.63%) or the 5-Fu plus ACT-D (100%) therapeutic regimens (p = 0.0676) or in the duration of treatment [MACT (3.50) or 5-Fu plus ACT-D (3.71; p = 0.2021)]. Moreover, the hospital stay in the 5-Fu plus ACT-D group (32.88 days) was significantly longer than for the MACT group (22.09 days; p < 0.001). Furthermore, the degree of myelosuppression, nausea and vomiting, diarrhoea, stomatitis and alopecia was more severe in the 5Fu + ACT-D group (p < 0.01). However, there was no statistical difference in the severity of liver function damage between the two groups. A shorter hospital stay, lower hospitalization cost and slightly more toxic effects were observed in LR-GTN patients treated with the MACT therapeutic regimen. We suggest that the MACT regimen should be used as first-line chemotherapy for LR-GTN.
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Affiliation(s)
- Yu Wang
- a Department of Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Jin-Wei Miao
- a Department of Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Tong Wang
- a Department of Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Yan Wang
- a Department of Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Yu-Mei Wu
- a Department of Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Wei-Min Kong
- a Department of Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Li Su
- a Department of Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Wei Duan
- a Department of Oncology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
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14
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Bolze PA, Riedl C, Massardier J, Lotz JP, You B, Schott AM, Hajri T, Golfier F. Mortality rate of gestational trophoblastic neoplasia with a FIGO score of ≥13. Am J Obstet Gynecol 2016; 214:390.e1-8. [PMID: 26433171 DOI: 10.1016/j.ajog.2015.09.083] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/26/2015] [Accepted: 09/23/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gestational trophoblastic diseases include premalignant (partial and complete hydatidiform moles) and malignant entities referred to as gestational trophoblastic neoplasia. Use of the International Federation of Gynecology and Obstetrics prognostic score is encouraged in cases of gestational trophoblastic neoplasia to predict the potential for the development of resistance to single-agent chemotherapy. An International Federation of Gynecology and Obstetrics score of ≥7 defines a high-risk patient and requires combination chemotherapy. Appropriate and rapid diagnosis, treatment by specialized centers, and reduction of early deaths at the time of chemotherapy initiation have led to significant improvements in survival for patients with high-risk gestational trophoblastic neoplasia. There is a crucial need for the early identification of high-risk patients with gestational trophoblastic neoplasia who have an increased death risk to organize their treatment in highly specialized centers. OBJECTIVES The purpose of this study was to describe cases of gestational trophoblastic neoplasia that have resulted in death, particularly in a subgroup with an International Federation of Gynecology and Obstetrics prognostic score of ≥13, for whom low-dose etoposide and cisplatin induction chemotherapy recently was shown to reduce early death rate. STUDY DESIGN We identified 974 patients from the French Center for Trophoblastic Diseases who had a diagnosis of gestational trophoblastic neoplasia from November 1999 to March 2014. Among 140 patients who were at high risk of resistance to single-agent chemotherapy (International Federation of Gynecology and Obstetrics score, ≥7), 29 patients (21%) had a score of ≥13. Mortality rate was estimated with the use of the Kaplan-Meier method. RESULTS The 5-year overall mortality rate, after the exclusion of placental site trophoblastic tumors and epithelioid trophoblastic tumors, was 2% for patients with gestational trophoblastic neoplasia (95% confidence interval, 1.25-3.13%). High-risk patients had a 5-year mortality rate of 12% (95% confidence interval, 7.49-18.9%). Patients with an International Federation of Gynecology and Obstetrics score of ≥13 had a higher 5-year mortality rate (38.4%; 95% confidence interval, 23.4-58.6%) and accounted for 52% of the deaths in the entire cohort. Early deaths, defined as those that occur within 4 weeks after treatment initiation, occurred in 8 patients of the entire cohort. Six of them had an International Federation of Gynecology and Obstetrics score of ≥13 at presentation, of whom 5 patients had brain and/or liver metastases. CONCLUSION Gestational trophoblastic diseases with an International Federation of Gynecology and Obstetrics score of ≥13 have an increased risk of early death. We suggest that an International Federation of Gynecology and Obstetrics score of ≥13 becomes a consensual criterion for prediction of patients with gestational trophoblastic neoplasia with increased risk of death, particularly early death. These patients justify treatment in highly specialized gestational trophoblastic disease centers and may benefit from the use of induction low-dose etoposide and cisplatin.
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15
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Ray S, Joy M, Sa B, Ghosh S, Chakraborty J. pH dependent chemical stability and release of methotrexate from a novel nanoceramic carrier. RSC Adv 2015. [DOI: 10.1039/c5ra03546e] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The study reveals maximum chemical stability of methotrexate in LDH–MTX at pH 7.00 and controlled release profile of PLGA–LDH–MTX.
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Affiliation(s)
- Sayantan Ray
- CSIR-Central Glass and Ceramic Research Laboratory
- Kolkata
- India
| | - Mathew Joy
- CSIR-Central Glass and Ceramic Research Laboratory
- Kolkata
- India
| | - Biswanath Sa
- Department of Pharmaceutical Technology
- Jadavpur University
- Kolkata
- India
| | | | - Jui Chakraborty
- CSIR-Central Glass and Ceramic Research Laboratory
- Kolkata
- India
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16
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Mousavi AS, Zamani A, Khorasanizadeh F, Gilani MM, Zendehdel K. Resistance to single-agent chemotherapy and its risk factors in low-risk gestational trophoblastic neoplasms. J Obstet Gynaecol Res 2014; 41:776-83. [DOI: 10.1111/jog.12613] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Azam Sadat Mousavi
- Gynecology Oncology Department; Valiasr Hospital, Faculty of Medicine; Imam Khomeini Hospital Complex; Tehran University of Medical Sciences; Tehran I.R of Iran
| | - Ashraf Zamani
- Gynecology Oncology Department; Valiasr Hospital, Faculty of Medicine; Imam Khomeini Hospital Complex; Tehran University of Medical Sciences; Tehran I.R of Iran
- Gynecology Oncology Department; Taleghani Hospital; Faculty of Medicine; Arak University of Medical Sciences; Arak I.R of Iran
| | - Faezeh Khorasanizadeh
- Students’ Scientific Research Center; Tehran I.R of Iran
- Cancer Research Center; Cancer Institute of Iran; Tehran University of Medical Sciences; Tehran I.R of Iran
| | - Mitra Modarres Gilani
- Gynecology Oncology Department; Valiasr Hospital, Faculty of Medicine; Imam Khomeini Hospital Complex; Tehran University of Medical Sciences; Tehran I.R of Iran
| | - Kazem Zendehdel
- Cancer Research Center; Cancer Institute of Iran; Tehran University of Medical Sciences; Tehran I.R of Iran
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17
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Early prediction of treatment resistance in low-risk gestational trophoblastic neoplasia using population kinetic modelling of hCG measurements. Br J Cancer 2013; 108:1810-6. [PMID: 23591194 PMCID: PMC3664307 DOI: 10.1038/bjc.2013.123] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: In low-risk gestational trophoblastic neoplasia (GTN) patients, a predictive marker for early identification of methotrexate (MTX) resistance would be useful. We previously demonstrated that kinetic modelling of human chorionic gonadotrophin (hCG) measurements could provide such a marker. Here we validate this approach in a large independent patient cohort. Methods: Serum hCG measurements of 800 low-risk GTN patients treated with MTX were analysed. The cohort was divided into Model and Test data sets. hCG kinetics were described from initial treatment day to day 50 using: ‘(hCG(time))=hCG0*exp(–k*time)+hCGres', where hCGres is the modelled residual production, hCG0 is the baseline hCG level, and k is the rate constant. HCGres-predictive value was investigated against previously reported predictors of MTX resistance. Results: Declining hCG measurements were well fitted by the model. The best discriminator of MTX resistance in the Model data set was hCGres, categorised by an optimal cut-off value of >20.44 IU l−1: receiver-operating characteristic (ROC) area under the curve (AUC)=0.87; Se=0.91; Sp=0.83. The predictive value of hCGres was reproducible using the Test data set: ROC AUC=0.87; Se=0.88; Sp=0.86. Multivariate analyses revealed hCGres as a better predictor of MTX resistance (HR=1.01, P<0.0001) and MTX failure-free survival (HR=13.25, P<0.0001) than other reported predictive factors. Conclusion: hCGres, a modelled kinetic parameter calculated after fully dosed three MTX cycles, has a reproducible value for identifying patients with MTX resistance.
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Berkowitz RS, Goldstein DP. Current advances in the management of gestational trophoblastic disease. Gynecol Oncol 2012; 128:3-5. [PMID: 22846466 DOI: 10.1016/j.ygyno.2012.07.116] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Ross S Berkowitz
- New England Trophoblastic Disease Center, Donald P. Goldstein Trophoblastic Tumor Registry, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
| | - Donald Peter Goldstein
- New England Trophoblastic Disease Center, Donald P. Goldstein Trophoblastic Tumor Registry, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
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Chen AZ, Li L, Wang SB, Zhao C, Liu YG, Wang GY, Zhao Z. Nanonization of methotrexate by solution-enhanced dispersion by supercritical CO2. J Supercrit Fluids 2012. [DOI: 10.1016/j.supflu.2012.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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20
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Mousavi A, Cheraghi F, Yarandi F, Gilani MM, Shojaei H. Comparison of pulsed actinomycin D versus 5-day methotrexate for the treatment of low-risk gestational trophoblastic disease. Int J Gynaecol Obstet 2011; 116:39-42. [PMID: 21996593 DOI: 10.1016/j.ijgo.2011.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/29/2011] [Accepted: 09/14/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the effectiveness of 2 standard chemotherapy regimens for low-risk gestational trophoblastic disease according to the International Federation of Gynecology and Obstetrics (FIGO) staging system. METHODS From 2008 until 2010, 75 women with low-risk gestational trophoblastic disease received either pulsed actinomycin D (n=50) or 5-day methotrexate (n=25). The primary remission rate, the duration of treatment, the number of treatment courses, and the adverse effects were compared. RESULTS The complete remission rates were 90% for the actinomycin D group and 68% for the methotrexate group (P=0.018). The mean number of chemotherapy courses administered to achieve complete remission (including courses of second-line therapy) was 3.1 in the methotrexate group and 5.3 in the actinomycin D group (P=0.01). No major adverse effects were experienced in either treatment group and there were no significant differences in terms of adverse effects. Second-line chemotherapy was indicated for 11 patients. CONCLUSION Based on the present study, pulsed actinomycin D seems to be an appropriate first-line treatment for patients with low-risk gestational trophoblastic disease.
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Affiliation(s)
- Azamsadat Mousavi
- Department of Gynecological Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kobayashi Y, Shimizu T, Naoe H, Ueki A, Ishizawa J, Chiyoda T, Onishi N, Sugihara E, Nagano O, Banno K, Kuninaka S, Aoki D, Saya H. Establishment of a choriocarcinoma model from immortalized normal extravillous trophoblast cells transduced with HRASV12. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:1471-82. [PMID: 21787741 DOI: 10.1016/j.ajpath.2011.05.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 05/12/2011] [Accepted: 05/23/2011] [Indexed: 01/06/2023]
Abstract
Gestational choriocarcinoma is a malignant trophoblastic tumor. The development of novel molecular-targeted therapies is needed to reduce the toxicity of current multiagent chemotherapy and to treat successfully the chemoresistant cases. The molecular mechanisms underlying choriocarcinoma tumorigenesis remain uncharacterized, however, and appropriate choriocarcinoma animal models have not yet been developed. In this study, we established a choriocarcinoma model by inoculating mice with induced-choriocarcinoma cell-1 (iC³-1) cells, generated from HTR8/SVneo human trophoblastic cells retrovirally transduced with activated H-RAS (HRASV12). The iC³-1 cells exhibited constitutive activation of the mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) pathways and developed into lethal tumors in all inoculated mice. Histopathological analysis revealed that the tumors consisted of two distinct types of cells, reminiscent of syncytiotrophoblasts and cytotrophoblasts, as seen in the human choriocarcinoma. The tumors expressed HLA-G and cytokeratin (trophoblast markers) and hCG (a choriocarcinoma marker). Comparative analysis of gene expression profiles between iC³-1 cells and parental HTR8/SVneo cells revealed that iC³-1 cells expressed matrix metalloproteinases, epithelial-mesenchymal transition-related genes, and SOX3 at higher levels than parental trophoblastic cells. Administration of SOX3-specific short-hairpin RNA decreased SOX3 expression and attenuated the tumorigenic activity of iC³-1 cells, suggesting that SOX3 overexpression might be critically involved in the pathogenesis of choriocarcinoma. Our murine model represents a potent new tool for studying the pathogenesis and treatment of choriocarcinoma.
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Affiliation(s)
- Yusuke Kobayashi
- Division of Gene Regulation, Institute for Advanced Medical Research, School of Medicine, Keio University and the Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Agency, Tokyo, Japan
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Rahaman J, Steiner N, Hayes MP, Chuang L, Fishman D, Gretz Iii H. Chemotherapy for gynecologic cancers. ACTA ACUST UNITED AC 2010; 76:577-88. [PMID: 20014427 DOI: 10.1002/msj.20143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review highlights significant recent developments and trends in chemotherapy for major gynecologic malignancies, i.e., ovarian cancer, endometrial cancer, uterine sarcomas, gestational trophoblastic neoplasia, and cervical cancer. In ovarian cancer, chemotherapeutic options for early, advanced and recurrent disease are in the adjuvant setting as well as in the neoadjuvant setting are explored. For uterine cancer, adjuvant chemotherapy is employed for high risk epithelial subtypes with early disease, such as uterine papillary serous carcinomas, uterine carcinosarcomas and leiomyosarcomas, advanced stage cases, as well as recurrent disease. The review then proceeds to further discuss the appropriate treatment based on the International Federation of Gynecology and Obstetrics prognostic scoring system for gestational trophoblastic neoplasia. Finally, chemotherapy is utilized in cervical cancer as neo-adjuvant therapy prior to surgery or radiation, as a sensitizer concomitantly with radiation therapy or for the treatment of advanced and recurrent disease.
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Siu MKY, Yeung MCW, Zhang H, Kong DSH, Ho JWK, Ngan HYS, Chan DCW, Cheung ANY. p21-Activated kinase-1 promotes aggressive phenotype, cell proliferation, and invasion in gestational trophoblastic disease. THE AMERICAN JOURNAL OF PATHOLOGY 2010; 176:3015-22. [PMID: 20413688 DOI: 10.2353/ajpath.2010.091263] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gestational trophoblastic disease (GTD) includes hydatidiform mole (HM), which can develop persistent gestational trophoblastic neoplasia requiring chemotherapy; choriocarcinoma, which is a frankly malignant tumor; placental site trophoblastic tumor; and epithelioid trophoblastic tumor. p21-Activated kinases (PAKs) promote malignant tumor progression. Therefore, this study investigated PAK1, PAK2, and p-PAK2 Ser(20) in the pathogenesis of GTD. By real-time PCR, PAK1 mRNA was significantly higher in HMs, particularly metastatic HMs (P = 0.046) and HMs that developed persistent disease (P = 0.011), when compared with normal placentas. By immunohistochemistry, significantly increased cytoplasmic PAK1 immunoreactivity in cytotrophoblasts was also detected in HMs (P = 0.042) and choriocarcinomas (P = 0.003). In addition, HMs that developed persistent disease displayed higher PAK1 immunoreactivity than those that regressed (P = 0.016), and elevated PAK1 immunoreactivity was observed in placental site trophoblastic tumors. Indeed, there was significant positive correlation between PAK1 expression and the proliferative indices Ki-67 (P = 0.016) and MCM7 (P = 0.026). Moreover, higher PAK1 mRNA and protein expression was confirmed in the choriocarcinoma cell-lines JEG-3 and JAR; however, PAK2 mRNA and p-PAK2 immunoreactivity showed a similar expression pattern in normal first trimester placentas and GTD. Knockdown of PAK1 in JEG-3 and JAR reduced cell proliferation, migration, and invasion ability, up-regulated p16, and down-regulated vascular endothelial growth factor and MT1-MMP expression. This is the first report revealing the involvement of PAK1 in the pathogenesis and clinical progress of GTD.
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Affiliation(s)
- Michelle K Y Siu
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
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Kang WD, Choi HS, Kim SM. Weekly methotrexate (50mg/m(2)) without dose escalation as a primary regimen for low-risk gestational trophoblastic neoplasia. Gynecol Oncol 2010; 117:477-80. [PMID: 20347479 DOI: 10.1016/j.ygyno.2010.02.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/25/2010] [Accepted: 02/27/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the efficacy and toxicity of an 8-day methotrexate-folinic acid regimen and a weekly methotrexate regimen (50mg/m(2) without dose escalation) for low-risk gestational trophoblastic neoplasia (GTN) according to the revised FIGO 2000 scoring system in a single institution. METHODS Between January 1997 and June 2007, 107 patients with low-risk GTN were treated with an 8-day methotrexate-folinic acid regimen (MTX-FA group; n=59) or a weekly methotrexate regimen (50mg/m(2) without dose escalation) (MTX group; n=48). The primary remission rate, change of chemotherapy because of drug resistance or toxicity, and relapse rate were compared. RESULTS All 107 patients with low-risk GTN were cured. The primary remission rates were 69.5% and 70.8% for the MTX-FA and MTX groups, respectively (P>0.99). The commonly reported toxic effects in the MTX-FA and MTX groups, respectively, were as follows: hepatotoxicity (31/59 and 9/48), neutropenia (7/59 and 4/48), stomatitis (3/59 and 2/48), alopecia (2/59 and 2/48), and thrombocytopenia (2/59 and 0/48). Drug toxicity necessitating changes in chemotherapy were reported to be 13.6% (8/59) in the MTX-FA group and 2.1% (1/48) in the MTX group (P<0.05). The overall duration of treatment was 8.6 weeks in the MTX-FA group and 6.4 weeks in the MTX group (P<0.001). CONCLUSIONS The weekly methotrexate regimen was as effective as the 8-day methotrexate-folinic acid regimen for low-risk GTN. The weekly methotrexate regimen was less toxic, better tolerated, and more convenient for patients compared to the 8-day methotrexate-folinic acid regimen.
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Affiliation(s)
- Woo Dae Kang
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
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You B, Pollet-Villard M, Fronton L, Labrousse C, Schott AM, Hajri T, Girard P, Freyer G, Tod M, Tranchand B, Colomban O, Ribba B, Raudrant D, Massardier J, Chabaud S, Golfier F. Predictive values of hCG clearance for risk of methotrexate resistance in low-risk gestational trophoblastic neoplasias. Ann Oncol 2010; 21:1643-1650. [PMID: 20154304 DOI: 10.1093/annonc/mdq033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early identification of patients at high risk for chemoresistance among those treated with methotrexate (MTX) for low-risk gestational trophoblastic neoplasia (GTN) is needed. We modeled human chorionic gonadotropin (hCG) decline during MTX therapy using a kinetic population approach to calculate individual hCG clearance (CL(hCG)) and assessed the predictive value of CL(hCG) for MTX resistance. PATIENTS AND METHODS A total of 154 patients with low-risk GTN treated with 8-day MTX regimen were retrospectively studied. NONMEM was used to model hCG decrease equations between day 0 and day 40 of chemotherapy. Receiver operating characteristic curve analysis defined the best CL(hCG) threshold. Univariate/multivariate survival analyses determined the predictive value of CL(hCG) and compared it with published predictive factors. RESULTS A monoexponential equation best modeled hCG decrease: hCG(t) = 3900 x e(-0.149 x t). Median CL(hCG) was 0.57 l/day (quartiles: 0.37-0.74). Only choriocarcinoma pathology [yes versus no: hazard ratio (HR) = 6.01; 95% confidence interval (CI) 2.2-16.6; P < 0.001] and unfavorable CL(hCG) quartile (< or =0.37 versus >0.37 l/day: HR = 6.75; 95% CI 2.7-16.8; P < 0.001) were significant independent predictive factors of MTX resistance risk. CONCLUSION In the second largest cohort of low-risk GTN patients reported to date, choriocarcinoma pathology and CL(hCG) < or =0.37 l/day were major independent predictive factors for MTX resistance risk.
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Affiliation(s)
- B You
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Medical Oncology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Medical Oncology Department, Drug Development Program, Princess Margaret Hospital, Toronto, Ontario, Canada.
| | - M Pollet-Villard
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Gynecology-Obstetrics Department, Hospices Civils de Lyon, Hôtel Dieu, Centre de Référence des Maladies Trophoblastiques, Lyon; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - L Fronton
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins
| | - C Labrousse
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Gynecology-Obstetrics Department, Hospices Civils de Lyon, Hôtel Dieu, Centre de Référence des Maladies Trophoblastiques, Lyon; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - A-M Schott
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; EA 4129, Université Lyon 1; Hospices Civils de Lyon, Réseau d'Epidémiologie Clinique International Francophone, Lyon
| | - T Hajri
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Gynecology-Obstetrics Department, Hospices Civils de Lyon, Hôtel Dieu, Centre de Référence des Maladies Trophoblastiques, Lyon; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - P Girard
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins
| | - G Freyer
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Medical Oncology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - M Tod
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins
| | - B Tranchand
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Centre Anticancéreux Léon Bérard, Lyon
| | - O Colomban
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins
| | - B Ribba
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; INRIA Grenoble Rhône-Alpes, Montbonnot, Saint Ismier Cedex
| | - D Raudrant
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Gynecology-Obstetrics Department, Hospices Civils de Lyon, Hôtel Dieu, Centre de Référence des Maladies Trophoblastiques, Lyon; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - J Massardier
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Gynecology-Obstetrics Department, Hospices Civils de Lyon, Hôtel Dieu, Centre de Référence des Maladies Trophoblastiques, Lyon; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - S Chabaud
- Biostatics Department, Unité de Biostatistique et d'évaluation thérapeutique, Centre Anticancereux Léon Bérard, Lyon, France
| | - F Golfier
- EA 3738, Université de Lyon, Lyon; Université Lyon 1, Faculté de Médecine Lyon Sud, Oullins; Gynecology-Obstetrics Department, Hospices Civils de Lyon, Hôtel Dieu, Centre de Référence des Maladies Trophoblastiques, Lyon; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite
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Ueda SM, Mao TL, Kuhajda FP, Vasoontara C, Giuntoli RL, Bristow RE, Kurman RJ, Shih IM. Trophoblastic neoplasms express fatty acid synthase, which may be a therapeutic target via its inhibitor C93. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 175:2618-24. [PMID: 19893031 PMCID: PMC2789637 DOI: 10.2353/ajpath.2009.081162] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/19/2009] [Indexed: 11/20/2022]
Abstract
Fatty acid synthase (FASN) is an emerging tumor-associated marker and a promising antitumor therapeutic target. In this study, we analyzed the expression of FASN in normal and molar placentas, as well as gestational trophoblastic neoplasia, and assessed the effects of a new FASN inhibitor, C93, on cellular proliferation and apoptosis in choriocarcinoma cells. Using a FASN-specific monoclonal antibody, we found that FASN immunoreactivity was detected in the cytotrophoblast and intermediate (extravillous) trophoblast of normal and molar placentas, as well as in placental site nodules. All choriocarcinomas (n = 33), 90% of epithelioid trophoblastic tumors (n = 20), and 60% of placental site trophoblastic tumors (n = 10) exhibited FASN positivity. FASN expression was further confirmed in vitro by Western blot and real-time PCR. Treatment of JEG3 and JAR cells with C93 induced significant apoptosis through the caspase-3/caspase-9/poly(ADP)ribose polymerase pathway. Cell cycle progression was not affected by the inhibitor. In summary, the data indicate that FASN is expressed in the majority of gestational trophoblastic neoplasias, and is essential for choriocarcinoma cells to survive and escape from apoptosis. FASN inhibitors such as C93 warrant further investigation as targeted therapeutic agents for metastatic and chemoresistant gestational trophoblastic neoplasia.
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Affiliation(s)
- Stefanie M Ueda
- Kelly Gynecologic Oncology Service, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Lertkhachonsuk AA, Israngura N, Wilailak S, Tangtrakul S. Actinomycin D Versus Methotrexate-Folinic Acid as the Treatment of Stage I, Low-Risk Gestational Trophoblastic Neoplasia. Int J Gynecol Cancer 2009; 19:985-8. [DOI: 10.1111/igc.0b013e3181a8333d] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chalouhi GE, Golfier F, Soignon P, Massardier J, Guastalla JP, Trillet-Lenoir V, Schott AM, Raudrant D. Methotrexate for 2000 FIGO low-risk gestational trophoblastic neoplasia patients: efficacy and toxicity. Am J Obstet Gynecol 2009; 200:643.e1-6. [PMID: 19393597 DOI: 10.1016/j.ajog.2009.03.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 01/16/2009] [Accepted: 03/06/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to review efficacy and toxicity of an 8-day methotrexate (MTX) regimen in the treatment of patients with low-risk gestational trophoblastic neoplasia (GTN) from the French Trophoblastic Disease Reference Center. STUDY DESIGN Between 1999 and 2006, 142 low-risk GTNs were diagnosed according to International Federation of Gynecology and Obstetrics (FIGO) criteria for GTN and to the FIGO scoring system. We report their characteristics, remission/resistance/recurrence rates, and treatment toxicity. RESULTS The 8-day MTX regimen achieved a 77.5% remission rate. All patients but 1 (99.9%) achieved remission and remained disease free until the time of analysis. Severe (grade 3 or 4) blood/bone marrow toxicity and metabolic/laboratory toxicity was noted in 4.2% of cases, of which 2 (1.4%) were grade 4. CONCLUSION For patients with GTN diagnosed according to FIGO criteria and considered low risk according to the FIGO scoring system, an 8-day MTX regimen is an adequate treatment associating a high rate of remission to a low rate of toxicity.
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Mohit M, Sarraf Z, Sheikhi G, Robati M, Vasheghani-Farahani A. Weekly intramuscular methotrexate in the treatment of low-risk gestational trophoblastic neoplasia. Arch Gynecol Obstet 2009; 280:775-80. [DOI: 10.1007/s00404-009-1014-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 02/17/2009] [Indexed: 11/24/2022]
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Yarandi F, Eftekhar Z, Shojaei H, Kanani S, Sharifi A, Hanjani P. Pulse methotrexate versus pulse actinomycin D in the treatment of low-risk gestational trophoblastic neoplasia. Int J Gynaecol Obstet 2008; 103:33-7. [DOI: 10.1016/j.ijgo.2008.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 05/04/2008] [Accepted: 05/12/2008] [Indexed: 10/21/2022]
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Treatment for low-risk gestational trophoblastic disease: Comparison of single-agent methotrexate, dactinomycin and combination regimens. Gynecol Oncol 2008; 108:149-53. [DOI: 10.1016/j.ygyno.2007.09.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 08/30/2007] [Accepted: 09/05/2007] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW Gestational trophoblastic neoplasia represents the malignant end of the gestational trophoblastic disease spectrum. This review updates readers on developments in the management of gestational trophoblastic neoplasia over the past few years. RECENT FINDINGS Progress has been made in elucidating the genetic changes that give rise to gestational trophoblastic neoplasia. The importance of accurate human chorionic gonadotrophin monitoring and the types of human chorionic gonadotrophin produced in cancer are also topical. Fortunately, most patients are cured with chemotherapy, and the choice of treatment schedule according to low-risk and high-risk prognostic groups is relatively unchanged. Indeed, most patients with low-risk gestational trophoblastic neoplasia are treated with single agent chemotherapy, and those who have high-risk disease with combination chemotherapy using etoposide, methotrexate and actinomycin D, alternating with cyclophosphamide and oncovine. For resistant disease, new paclitaxel-containing regimens appear better tolerated than etoposide and cisplatin alternating weekly with etoposide, methotrexate and actinomycin D. SUMMARY Prognosis in gestational trophoblastic neoplasia is now excellent following treatment. Virtually all patients with low-risk disease are cured, and survival is now 86% in high-risk patients. Optimization of treatment strategies for those who develop drug resistance remains a key challenge.
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Affiliation(s)
- Sarah Ngan
- Department of Medical Oncology, Imperial College, Charing Cross Hospital, London, UK
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