EMACO for treatment of gestational trophoblastic neoplasia: A multinational multicenter study

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Autor(es): dc.contributorMahidol University-
Autor(es): dc.contributorNiterói-
Autor(es): dc.contributorUniversidade Estadual Paulista (UNESP)-
Autor(es): dc.contributorHarvard Medical School-
Autor(es): dc.contributorUniversity of Miskolc-
Autor(es): dc.contributorVassouras University-
Autor(es): dc.contributorUniversity of Caldas-
Autor(es): dc.creatorJareemit, Nida-
Autor(es): dc.creatorTherasakvichya, Suwanit-
Autor(es): dc.creatorFreitas, Fernanda-
Autor(es): dc.creatorPaiva, Gabriela-
Autor(es): dc.creatorRamírez, Luz Angela Correa-
Autor(es): dc.creatorBerkowitz, Ross S.-
Autor(es): dc.creatorHorowitz, Neil S.-
Autor(es): dc.creatorMaestá, Izildinha-
Autor(es): dc.creatorFülöp, Vilmos-
Autor(es): dc.creatorBraga, Antonio-
Autor(es): dc.creatorElias, Kevin M.-
Data de aceite: dc.date.accessioned2025-08-21T17:27:02Z-
Data de disponibilização: dc.date.available2025-08-21T17:27:02Z-
Data de envio: dc.date.issued2023-07-29-
Data de envio: dc.date.issued2023-07-29-
Data de envio: dc.date.issued2023-03-01-
Fonte completa do material: dc.identifierhttp://dx.doi.org/10.1016/j.ygyno.2022.12.020-
Fonte completa do material: dc.identifierhttp://hdl.handle.net/11449/248233-
Fonte: dc.identifier.urihttp://educapes.capes.gov.br/handle/11449/248233-
Descrição: dc.descriptionObjective: To investigate the efficacy and toxicity of etoposide, methotrexate, actinomycin D alternating with cyclophosphamide, and vincristine (EMACO) for treatment of gestational trophoblastic neoplasia, and for factors independently associated with EMACO resistance and disease-specific death in an international cohort. Methods: Medical records of GTN patients who received EMACO during 1986–2019 from gestational trophoblastic disease centers from four countries including the USA, Thailand, Hungary, and Brazil, were retrospectively reviewed. Among 335 GTN patients, 266 patients who received EMACO as primary chemotherapy were included in the primary treatment group, and 69 patients who received EMACO after relapse/resistance to single-agent chemotherapy were included in the prior treatment group. Results: Three-quarters (76.1%) of all patients achieved remission, and the survival rate was 89%. The prior treatment group had better outcomes than the primary treatment group relative to remission rate (87.0% vs. 73.3%, p = 0.014) and number of EMACO cycles to achieve remission (3 vs. 6 cycles, p < 0.001). Sustained remission increased to 87.2% in EMACO-resistant patients treated with later-line chemotherapy. Number of metastatic organs ≥2 (adjusted odds ratio [aOR]: 2.33, p = 0.049) was the only independent predictor of EMACO resistance among overall patients. Interval from index pregnancy ≥7 months (aOR: 4.34, p = 0.001), and pretreatment hCG >100,000 IU/L (aOR: 2.85, p = 0.028) were independent predictors of EMACO resistance in the high-risk subgroup. The only factor independently associated with disease-specific death was EMACO resistance (aOR: 176.04, p < 0.001). Conclusions: EMACO is an effective treatment for GTN. Number of metastatic organs and EMACO resistance were the independent predictors of EMACO resistance and disease-specific death, respectively.-
Descrição: dc.descriptionConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)-
Descrição: dc.descriptionFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)-
Descrição: dc.descriptionDivision of Gynaecologic Oncology Department of Obstetrics and Gynaecology Faculty of Medicine Siriraj Hospital Mahidol University-
Descrição: dc.descriptionRio de Janeiro Trophoblastic Disease Centre Maternity School of Rio de Janeiro Federal University Antonio Pedro University Hospital of Fluminense Federal University Niterói-
Descrição: dc.descriptionPostgraduation Program in Tocoginecology Botucatu Medical School São Paulo State University - UNESP-
Descrição: dc.descriptionNew England Trophoblastic Disease Center Division of Gynecologic Oncology Department of Obstetrics Gynecology and Reproductive Biology Brigham and Women's Hospital Harvard Medical School-
Descrição: dc.descriptionBotucatu Trophoblastic Disease Center of the Clinical Hospital of Botucatu Medical School Department of Gynecology and Obstetrics São Paulo State University - UNESP-
Descrição: dc.descriptionDepartment of Obstetrics and Gynecology Medical Centre Hungarian Defense Forces Semmelweis University National Trophoblastic Disease Center Budapest Faculty of Health Sciences University of Miskolc-
Descrição: dc.descriptionPostgraduate Program in Applied Health Sciences Vassouras University, RJ-
Descrição: dc.descriptionClinical Department University of Caldas, Caldas-
Descrição: dc.descriptionPostgraduation Program in Tocoginecology Botucatu Medical School São Paulo State University - UNESP-
Descrição: dc.descriptionBotucatu Trophoblastic Disease Center of the Clinical Hospital of Botucatu Medical School Department of Gynecology and Obstetrics São Paulo State University - UNESP-
Descrição: dc.descriptionFAPESP: 2020/08830-6-
Descrição: dc.descriptionCNPq: 311862/2020-9-
Formato: dc.format114-122-
Idioma: dc.languageen-
Relação: dc.relationGynecologic Oncology-
???dc.source???: dc.sourceScopus-
Palavras-chave: dc.subjectDisease-specific death-
Palavras-chave: dc.subjectEfficacy-
Palavras-chave: dc.subjectGestational trophoblastic disease-
Palavras-chave: dc.subjectMultiagent chemotherapy-
Palavras-chave: dc.subjectResistance-
Palavras-chave: dc.subjectToxicity-
Título: dc.titleEMACO for treatment of gestational trophoblastic neoplasia: A multinational multicenter study-
Tipo de arquivo: dc.typelivro digital-
Aparece nas coleções:Repositório Institucional - Unesp

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