Comparison of treatment for low-risk GTN with standard 8-day MTX/FA regimen versus modified MTX/FA regimen without chemotherapy on the weekend

• Published in: Gynecologic oncology Vol. 156; no. 3; pp. 598 - 605
• Main Authors: Braga, Antonio, de Souza Hartung Araújo, Clymene, Mora, Paulo Alexandre Ribeiro, Paulino, Eduardo, de Melo, Andréia Cristina, Velarde, Guillermo Coca, dos Santos Esteves, Ana Paula Vieira, Junior, Joffre Amim, Filho, Jorge Rezende, Elias, Kevin M., Horowitz, Neil S., Berkowitz, Ross S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2020
• Subjects: Chemotherapy; Gestational trophoblastic neoplasia; Methotrexate; Methotrexate-resistance; Chemotherapy; Methotrexate-resistance; Methotrexate; Gestational trophoblastic neoplasia
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2019.12.044

To compare the outcomes of patients with low-risk gestational trophoblastic neoplasia (GTN) treated with standard 8-day methotrexate/folinic acid (MTX/FA) versus modified regimen.
Retrospective cohort study of patients with low-risk GTN followed at Rio de Janeiro Federal University, from January/1990-December/2017 with standard 8-day MTX/FA or modified regimen (MTX administered on the 8th day rather than 7th) to avoid treatment on the weekend.
From 937 patients with low-risk GTN, 538 were treated with standard MTX/FA and 98 patients received modified regimen. Both groups were comparable in age (p = .749), antecedent pregnancy (p = .221), time to initiate chemotherapy (p = .926), hCG pretreatment level (p = .112) and WHO/FIGO prognostic risk score (p = .723). Patients treated with modified MTX/FA had twice of cases of metastatic lung disease compared with the standard regimen (22.5% vs 10.6%; p = .002). The rate of remission (p = .999), number of cycles to remission in the first-line (p = .966), chemoresistance (p = .500), time to switch to second-line therapy (p = .176), need for multiagent chemotherapy (p = .084), relapse (p = .122) or death (p = .475) was the same for both MTX/FA regimen. However, although patients receiving modified MTX/FA required a higher total number of remission cycles (6 vs 5 cycles; p = .004) and longer time to remission (19 vs 16 weeks; p < .001) when compared with the standard regimen, these variables showed no significant differences after multivariate logistic regression adjusted for lung metastasis.
The modified 8-day MTX/FA regimen didn't compromise oncologic outcomes for women with low-risk GTN. This regimen appears to be an acceptable alternative to standard 8-day MTX/FA when treatment on weekend isn't an option.
•Low-risk GTN didn’t appear to have compromised oncologic outcomes when treated with modified 8-day MTX/FA.•Modified 8-day MTX/FA didn’t appear to increase chemoresistance, number of chemotherapy cycles to achieve remission or toxicity.•When treatment on weekends isn’t an option, the modified 8-day MTX/FA appears to be an acceptable alternative.