Salvage chemotherapy for gestational trophoblastic neoplasia: Utility or futility?

Kathleen G. Essel, Amanda Bruegl, David M. Gershenson, Lois M. Ramondetta, R. Wendel Naumann, Jubilee Brown

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective To determine the efficacy of chemotherapy after failed initial treatment in patients with high risk gestational trophoblastic neoplasia (GTN). Methods We performed a retrospective IRB-approved chart review of all patients with GTN seen at a single institution from 1985 to 2015, including all patients who failed initial treatment. We summarized clinical characteristics with descriptive statistics and estimated progression-free survival (PFS) and overall survival (OS) with the Kaplan-Meier method. Results Of 68 identified patients, 38 required > 2 chemotherapy regimens. Patients were treated for GTN (n = 53), including choriocarcinoma, persistent GTN, and invasive mole; for placental site trophoblastic tumor (PSTT) (n = 5); and for intermediate trophoblastic tumor (ITT) (n = 10). Patients with GTN had a median of 2 salvage regimens, median PFS of 4.0 months, and median OS was not reached at median follow-up of 71.2 months. Active regimens included EMACO, MAC, BEP, platinum- and etoposide-based combination therapies, and ICE; 8 of 53 patients died of disease (DOD). Patients with PSTT had a median of 3 salvage regimens, median PFS of 2.8 months, and median OS of 38.8 months. Active regimens included ICE and EMA-EP; 4 of 5 patients DOD. Patients with ITT had a median of 3 salvage regimens, median PFS of 4.1 months, and median OS of 38.2 months. Active regimens included liposomal doxorubicin, platinum-containing regimens, EMA-CO, and EMA-EP; 7 of 10 patients DOD. Conclusions Several salvage chemotherapy regimens demonstrate activity in high risk GTN. Multiple regimens may be required and cure is not universal.

Original languageEnglish (US)
Pages (from-to)74-80
Number of pages7
JournalGynecologic Oncology
Volume146
Issue number1
DOIs
StatePublished - Jul 1 2017

Fingerprint

Gestational Trophoblastic Disease
Medical Futility
Drug Therapy
Disease-Free Survival
Placental Site Trophoblastic Tumor
Trophoblastic Neoplasms
Survival
Platinum
Invasive Hydatidiform Mole
Choriocarcinoma
Research Ethics Committees
Etoposide
Carbon Monoxide
Therapeutics

Keywords

  • Chemotherapy
  • Gestational trophoblastic neoplasia
  • Placental site trophoblastic tumor
  • Salvage

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Essel, K. G., Bruegl, A., Gershenson, D. M., Ramondetta, L. M., Naumann, R. W., & Brown, J. (2017). Salvage chemotherapy for gestational trophoblastic neoplasia: Utility or futility? Gynecologic Oncology, 146(1), 74-80. https://doi.org/10.1016/j.ygyno.2017.04.017

Salvage chemotherapy for gestational trophoblastic neoplasia : Utility or futility? / Essel, Kathleen G.; Bruegl, Amanda; Gershenson, David M.; Ramondetta, Lois M.; Naumann, R. Wendel; Brown, Jubilee.

In: Gynecologic Oncology, Vol. 146, No. 1, 01.07.2017, p. 74-80.

Research output: Contribution to journalArticle

Essel, KG, Bruegl, A, Gershenson, DM, Ramondetta, LM, Naumann, RW & Brown, J 2017, 'Salvage chemotherapy for gestational trophoblastic neoplasia: Utility or futility?', Gynecologic Oncology, vol. 146, no. 1, pp. 74-80. https://doi.org/10.1016/j.ygyno.2017.04.017
Essel, Kathleen G. ; Bruegl, Amanda ; Gershenson, David M. ; Ramondetta, Lois M. ; Naumann, R. Wendel ; Brown, Jubilee. / Salvage chemotherapy for gestational trophoblastic neoplasia : Utility or futility?. In: Gynecologic Oncology. 2017 ; Vol. 146, No. 1. pp. 74-80.
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abstract = "Objective To determine the efficacy of chemotherapy after failed initial treatment in patients with high risk gestational trophoblastic neoplasia (GTN). Methods We performed a retrospective IRB-approved chart review of all patients with GTN seen at a single institution from 1985 to 2015, including all patients who failed initial treatment. We summarized clinical characteristics with descriptive statistics and estimated progression-free survival (PFS) and overall survival (OS) with the Kaplan-Meier method. Results Of 68 identified patients, 38 required > 2 chemotherapy regimens. Patients were treated for GTN (n = 53), including choriocarcinoma, persistent GTN, and invasive mole; for placental site trophoblastic tumor (PSTT) (n = 5); and for intermediate trophoblastic tumor (ITT) (n = 10). Patients with GTN had a median of 2 salvage regimens, median PFS of 4.0 months, and median OS was not reached at median follow-up of 71.2 months. Active regimens included EMACO, MAC, BEP, platinum- and etoposide-based combination therapies, and ICE; 8 of 53 patients died of disease (DOD). Patients with PSTT had a median of 3 salvage regimens, median PFS of 2.8 months, and median OS of 38.8 months. Active regimens included ICE and EMA-EP; 4 of 5 patients DOD. Patients with ITT had a median of 3 salvage regimens, median PFS of 4.1 months, and median OS of 38.2 months. Active regimens included liposomal doxorubicin, platinum-containing regimens, EMA-CO, and EMA-EP; 7 of 10 patients DOD. Conclusions Several salvage chemotherapy regimens demonstrate activity in high risk GTN. Multiple regimens may be required and cure is not universal.",
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AU - Essel, Kathleen G.

AU - Bruegl, Amanda

AU - Gershenson, David M.

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AU - Naumann, R. Wendel

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N2 - Objective To determine the efficacy of chemotherapy after failed initial treatment in patients with high risk gestational trophoblastic neoplasia (GTN). Methods We performed a retrospective IRB-approved chart review of all patients with GTN seen at a single institution from 1985 to 2015, including all patients who failed initial treatment. We summarized clinical characteristics with descriptive statistics and estimated progression-free survival (PFS) and overall survival (OS) with the Kaplan-Meier method. Results Of 68 identified patients, 38 required > 2 chemotherapy regimens. Patients were treated for GTN (n = 53), including choriocarcinoma, persistent GTN, and invasive mole; for placental site trophoblastic tumor (PSTT) (n = 5); and for intermediate trophoblastic tumor (ITT) (n = 10). Patients with GTN had a median of 2 salvage regimens, median PFS of 4.0 months, and median OS was not reached at median follow-up of 71.2 months. Active regimens included EMACO, MAC, BEP, platinum- and etoposide-based combination therapies, and ICE; 8 of 53 patients died of disease (DOD). Patients with PSTT had a median of 3 salvage regimens, median PFS of 2.8 months, and median OS of 38.8 months. Active regimens included ICE and EMA-EP; 4 of 5 patients DOD. Patients with ITT had a median of 3 salvage regimens, median PFS of 4.1 months, and median OS of 38.2 months. Active regimens included liposomal doxorubicin, platinum-containing regimens, EMA-CO, and EMA-EP; 7 of 10 patients DOD. Conclusions Several salvage chemotherapy regimens demonstrate activity in high risk GTN. Multiple regimens may be required and cure is not universal.

AB - Objective To determine the efficacy of chemotherapy after failed initial treatment in patients with high risk gestational trophoblastic neoplasia (GTN). Methods We performed a retrospective IRB-approved chart review of all patients with GTN seen at a single institution from 1985 to 2015, including all patients who failed initial treatment. We summarized clinical characteristics with descriptive statistics and estimated progression-free survival (PFS) and overall survival (OS) with the Kaplan-Meier method. Results Of 68 identified patients, 38 required > 2 chemotherapy regimens. Patients were treated for GTN (n = 53), including choriocarcinoma, persistent GTN, and invasive mole; for placental site trophoblastic tumor (PSTT) (n = 5); and for intermediate trophoblastic tumor (ITT) (n = 10). Patients with GTN had a median of 2 salvage regimens, median PFS of 4.0 months, and median OS was not reached at median follow-up of 71.2 months. Active regimens included EMACO, MAC, BEP, platinum- and etoposide-based combination therapies, and ICE; 8 of 53 patients died of disease (DOD). Patients with PSTT had a median of 3 salvage regimens, median PFS of 2.8 months, and median OS of 38.8 months. Active regimens included ICE and EMA-EP; 4 of 5 patients DOD. Patients with ITT had a median of 3 salvage regimens, median PFS of 4.1 months, and median OS of 38.2 months. Active regimens included liposomal doxorubicin, platinum-containing regimens, EMA-CO, and EMA-EP; 7 of 10 patients DOD. Conclusions Several salvage chemotherapy regimens demonstrate activity in high risk GTN. Multiple regimens may be required and cure is not universal.

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KW - Gestational trophoblastic neoplasia

KW - Placental site trophoblastic tumor

KW - Salvage

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