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Title:

Low-Risk Gestational Trophoblastic Neoplasia and Methotrexate Resistance: Predictors of Response to Treatment with Actinomycin D and Need for Combination Chemotherapy

Authors:

W. B. Growdon, M.D., A. J. Wolfberg, M.D., M.P.H., D. P. Goldstein, M.D., C. M. Feltmate, M.D., M. E. Chinchilla, M.S., E. S. Lieberman, M.D., Dr.P.H. and R. S. Berkowitz, M.D.

OBJECTIVE: To determine whether any clinical parameters predict the need for multiagent chemotherapy for treatment of low-risk gestational trophoblastic neoplasia (GTN) after the development of methotrexate (MTX) resistance.

STUDY DESIGN: We retrospectively analyzed clinical data from the New England Trophoblastic Disease Center from women with post– molar GTN between 1973 and 2003.

RESULTS: We analyzed data from 150 women (40 with partial mole, 110 with complete mole) who received single- agent MTX for low-risk GTN using FIGO and WHO scoring systems. Of the 45 women who developed MTX resistance, the majority (37/45) of these patients received actinomycin D, with 10 patients ultimately requiring multiagent chemotherapy. The requirement for multiagent chemotherapy following MTX resistance was associated with a b-hCG >600 mIU/mL 1 week following initial MTX therapy (p<0.03). Conversely, a b-hCG <600 mIU/mL 1 week following initial MTX therapy was associated with a 93% probability of remission with actinomycin D alone. All patients went into durable remission.

CONCLUSION: The prognosis for patients with low-risk GTN following molar gestation is excellent, with 100% remission rate, though a small but significant proportion (7%) required multiagent chemotherapy. The need for multiagent chemotherapy was associated with b-hCG levels 1 week following initial MTX therapy.

Keywords:

gestational trophoblastic disease, molar pregnancy

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