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2022-RA-1371-ESGO Multiple-agent chemotherapy as first-line treatment for low risk gestational neoplasm: is it time or not?
  1. Fariba Yarandi1,
  2. Elham Shirali1,
  3. Zahra Haghi2,
  4. Saeed Haghi3 and
  5. Sara Ramhormozian1
  1. 1Oncology, Tehran University Medical Science, Tehran, Iran, Islamic Republic of
  2. 2Shahid beheshti University, Tehran, Iran, Islamic Republic of
  3. 3Azad university, Tehran, Iran, Islamic Republic of


Introduction/Background Gestational trophoblastic neoplasm(GTN) which is categorized as low-risk and high-risk,is a rare disease by itself. Most low-risk GTN patients are treated with single-agent chemotherapy;however, the multi-agent protocol is the first choice of treatment for high-risk GTN patients.This study aimed to assess the causes of resistance in low-risk GTN patients undergoing single-agent chemotherapy.

Methodology In this case-control study,we evaluated 207 low-risk GTN patients who were diagnosed and treated at the Oncology Department of referral hospitals in Tehran,Iran between 2011 and 2017. Patients with FIGO stage I were considered as low-risk and standard pulse methotrexate(MTX) or pulse actinomycin-D was started for them.In cases of resistance to first-line single-agent chemotherapy, second-line single-agent and if still resistant, multi-agent chemotherapy with EMA-CO(etoposide, methotrexate, actinomycin D, cyclophosphamide, oncovin)was used. Data were analyzed by SPSS version 22

Results Among all patients,152(73.4%) responded to single-agent chemotherapy, 24 (11.6%) responded to second-line chemotherapy and 31 (15%) required multi-agent chemotherapy.Four cases underwent emergent hysterectomy due to uterine rupture which have been excluded.Significant difference in mean tumor size and FIGO score was found among the three groups of first-line single-agent,second-line single-agent and multi-agent responders;however,response to treatment was not correlated with many factors such as level of Β-HCG(B-Human Chorionic Gonadotropin)and duration of treatment.Univariate analyses showed that many clinical features such as tumor size (P<0.001) and Β-HCG>40,000 accompanied by tumor size ≥ 5 cm (P=0.005) were significantly correlated with the risk of resistance to single-agent chemotherapy.

Conclusion Although more research is needed to suggest multi-agent chemotherapy administration from the beginning for low risk GTN patients at risk for chemotherapy resistance, factors such as tumor size>5 cm accompanied with B-HCG>40000 and FIGO score ≥ 4 can alarm the clinician to better predict possibility of chemotherapy resistance and keep an eye on the patients until normal B-HCG levels are achieved.

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