Efficacy of Single Agent Chemotherapy in Management lowRisk GTN Cases

Objective: Low risk gestational trophoblastic neoplasia (GTN) is a curable disease if appropriate management wasperformed. This study carried out to determine the efficacy of methotrexate (MTX) versus Actinomycin D(ACT) as the initial single agent chemotherapy(ChT) in treatment of low risk GTN cases. In addition prognosticfactors of resistance cases of ChTwas evaluated.Methods: This prospective cohort study was conducted on the 110 patient with low risk GTN candied to single agent ChT.All patients were referrals cases to anacademic oncology center between2012 to 2017.The treatment response and failure of each chemotherapy was analysis.Results: 110patients was treated initially with weekly (50 mg/m2) MTX and10 patients treated with ACT regimen (1.25 mg/m2 biweeklyat first line drug. Due to MTX-resistance, 20Patients need to switch drug to ACTand in 3 of the others becausetreatment-related adverse effect, the drug changed to ACT.Complete remission achieved in71% of patientswhich treated with MTX and in 78.7 % cases of ACT group. The overall response rate for all single agent ChT was occurred in 90.3% of cases.Risk factors in resistance to first line ChTin patients who received MTX were; pathology of coriocarcinoma ,higher level pretreatment of Β-HCG titer , presence of metastases diseases,delay in initiating treatment and lack of proper collaboration the patient s.Conclusions: Primary remissionrates MTX was lower than ACT regimenrespectively

Keywords:

gestational trophoblastic neoplasia , single agent chemotherapy , methotrexate , Actinomycin