Low Risk Trophoblastic Neoplasia: Outcome after Initial Treatment with Single Agent Intramuscular Methotrexate and Oral Folinic Acid
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- Category: Vol. 82, March 2014
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Low Risk Trophoblastic Neoplasia: Outcome after Initial Treatment with Single Agent Intramuscular Methotrexate and Oral Folinic Acid, GHADA E. ELADAWEI
Abstract
Background: Low risk gestational trophoblastic neoplasia (GTN) is defined as persistent molar pregnancy with a FIGO/ WHO score less than seven. The optimal chemotherapeutic regimen still remains controversial. The aim of this study was to determine the complete response rate and toxicity of single agent methotrexate in low risk GTN, furthermore detection of possible predictors of treatment failure with single agent methotrexate.
Patients and Methods: Medical records of patients with low risk gestational trophoblastic neoplasia were reviewed from January 2003 to December 2012. Eighty six patients were treated with 2 weekly intramascular methotrexate 50mg four doses days 1,3,5,7 and oral folinic acid 15mg days 2,4,6,8 (MTX/FA). Patient data were collated and correlation between FIGO/WHO risk score and outcome were evaluated.
Results: Overall response rate was 74.4% as, 64/86 patients treated with MTX/FA achieved complete biochemical response, while 22 patients (25.6%) developed resistance. Patients with FIGO/WHO score 6 were more likely to develop resistance and require second line chemotherapy than those with score between 0 and 5. Nine patients out of eleven with score 6 (81.8%) developed resistance compared to 13/75 patients (17.3%) scoring 0-5 (p<0.001). Eight patients who had scored FIGO/WHO 6 also had score 4 for hCG level and Seven of these patients (87.5%) developed Methotrexate resistance and required second line chemotherapy.
Conclusion: Intramuscular methotrexate with oral folinic acid rescue is an effective, well tolerated and low coast regimen for the treatment of low risk gestational trophoblastic neoplasia. However, patients must be fully informed of the likelihood of requiring salvage chemotherapy to achieve cure. It would be helpful to refine the FIGO/WHO scoring system, as 81.8% of patients with score 6 developed MTX/FA resistance could be identified initially for more intensive therapy.