June 30th, 2022

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Management of Drug Resistant Gestational Trophoblastic Neoplasia
Authors:  S. M. Patel, M.D., and A. Desai, M.D.
  OBJECTIVE: To determine the outcome of secondary management in drug-resistant gestational trophoblastic neoplasia (GTN).

STUDY DESIGN: Sixteen of 60 patients with GTN (8 low-risk and 8 high-risk) who developed resistance to primary chemotherapy were studied retrospectively. Primary chemotherapy was methotrexate–folinic acid rescue (MTX-FA) for low risk and etoposide/methotrexate/actinomycin D/cyclophosphamide/vincristine (EMA-CO) for high risk. Secondary chemotherapy for the low-risk group was either actinomycin D or EMA-CO, depending on serum beta human chorionic gonadotropin (hCG) levels at resistance. For the high-risk group, etoposide/methotrexate/actinomycin D/cisplatinum (EMA-EP) or bleomycin/etoposide/cisplatin (BEP) was given. Third-line chemotherapy was vincristine/actinomycin D/cyclophosphamide (VAC) or vincristine/ iphosphamide/cisplatin (VIP). Surgery and radiotherapy were used in selected patients.

RESULTS: Survival after salvage therapy in low-risk patients was 100%: 2 with EMA-CO and 6 with actinomycin D. Of high-risk cases 75% were cured with EMA-EP or BEP. Third-line chemotherapy was given in 2 patients: 1 was lost to follow-up and the other died. Survival was significantly influenced by both hCG level at the start of secondary therapy and site of metastasis.

CONCLUSION: Prognosis in GTN is excellent. Optimization of treatment strategies for those who develop drug resistance remains a key challenge.
Keywords:  drug resistance, gestational trophoblastic neoplasia, second-line treatment
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