Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia

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Autor(es): dc.contributorUniversidade Estadual Paulista (Unesp)-
Autor(es): dc.contributorBrigham and Women's Hospital-
Autor(es): dc.contributorHarvard Medical School-
Autor(es): dc.creatorMaestá, Izildinha [UNESP]-
Autor(es): dc.creatorNitecki, Roni-
Autor(es): dc.creatorDesmarais, Cecilia Canedo Freitas [UNESP]-
Autor(es): dc.creatorHorowitz, Neil S.-
Autor(es): dc.creatorGoldstein, Donald P.-
Autor(es): dc.creatorElias, Kevin M.-
Autor(es): dc.creatorBerkowitz, Ross S.-
Data de aceite: dc.date.accessioned2022-02-22T00:29:08Z-
Data de disponibilização: dc.date.available2022-02-22T00:29:08Z-
Data de envio: dc.date.issued2020-12-11-
Data de envio: dc.date.issued2020-12-11-
Data de envio: dc.date.issued2020-05-01-
Fonte completa do material: dc.identifierhttp://dx.doi.org/10.1016/j.ygyno.2020.02.001-
Fonte completa do material: dc.identifierhttp://hdl.handle.net/11449/200030-
Fonte: dc.identifier.urihttp://educapes.capes.gov.br/handle/11449/200030-
Descrição: dc.descriptionObjectives: The purpose of this study was to evaluate both the outcomes and toxicity of second-line actinomycin D (ActD) chemotherapy in methotrexate (MTX) - resistant low-risk postmolar gestational trophoblastic neoplasia (GTN) with 5-day ActD versus pulsed ActD. Methods: This retrospective cohort study included patients with MTX-resistant low-risk postmolar GTN from 1974 to 2016. Second-line chemotherapy consisted of 5-day ActD (10–12 μg/kg per day for 5 days every 14 days) or biweekly ActD (1.25 mg/m2 every 2 weeks). Data on patient characteristics, disease presentation, treatment outcome, and toxicity were collected. Results: Sixty-eight MTX-resistant patients receiving ActD as second-line chemotherapy were identified (5-day ActD, 53 patients; pulsed ActD, 15 patients). No significant differences were observed in patient/disease characteristics and sustained remission (overall rate 72%) between second-line ActD regimens. Time to hCG remission was significantly faster (median 21 vs 47 days, p = .04) and required fewer treatment cycles (median 1 vs 2, p < .001) with 5-day ActD. Thrombocytopenia was only observed with 5-day ActD (64.6 vs 0%, p < .001). The frequency (60.4 vs 16.7%, p = .009) and severity (grade 3: 37.9 vs 0%, p = .045) of oral mucositis was significantly higher with 5-day ActD. Grade 2 alopecia was significantly more frequent (70.6 vs 16.7%, p = .02) with 5-day ActD. Conclusions: While 5-day ActD and pulsed ActD achieve comparable remission rates, due to its reduced toxicity, ease of administration, and patient convenience, pulsed ActD should be the treatment of choice for MTX-resistant postmolar low-risk GTN.-
Descrição: dc.descriptionCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)-
Descrição: dc.descriptionBotucatu Trophoblastic Disease Center Botucatu Medical School Hospital Department of Gynecology and Obstetrics UNESP—Sao Paulo State University-
Descrição: dc.descriptionPostgraduate Program in Tocogynecology of Botucatu Medical School UNESP—São Paulo State University-
Descrição: dc.descriptionDepartment of Obstetrics and Gynecology Brigham and Women's Hospital-
Descrição: dc.descriptionNew England Trophoblastic Disease Center Division of Gynecologic Oncology Department of Obstetrics Gynecology and Reproductive Biology Brigham and Women's Hospital-
Descrição: dc.descriptionHarvard Medical School-
Descrição: dc.descriptionBotucatu Trophoblastic Disease Center Botucatu Medical School Hospital Department of Gynecology and Obstetrics UNESP—Sao Paulo State University-
Descrição: dc.descriptionPostgraduate Program in Tocogynecology of Botucatu Medical School UNESP—São Paulo State University-
Formato: dc.format372-378-
Idioma: dc.languageen-
Relação: dc.relationGynecologic Oncology-
???dc.source???: dc.sourceScopus-
Palavras-chave: dc.subjectActinomycin D-
Palavras-chave: dc.subjectEffectiveness-
Palavras-chave: dc.subjectLow-risk gestational trophoblastic neoplasia-
Palavras-chave: dc.subjectSecond-line chemotherapy-
Palavras-chave: dc.subjectToxicity-
Título: dc.titleEffectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia-
Tipo de arquivo: dc.typelivro digital-
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