C Even1, P Pautier1, P Duvillard2, A Floquet3, P Kerbrat4, F Troalen2, A Rey5, C Balleyguier6, Y Tazi1, A Leary1, P Augereau7, P Morice8, J-P Droz9, K Fizazi1, C Lhommé10. 1. Department of Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France. 2. Department of Biopathology, Gustave Roussy, University of Paris Sud, Villejuif, France. 3. Institut Bergonié, Bordeaux, France. 4. Centre Eugène Marquis, Rennes, France. 5. Department of Biostatistics, Gustave Roussy, University of Paris Sud, Villejuif, France. 6. Department of Radiology, Gustave Roussy, University of Paris Sud, Villejuif, France. 7. Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France. 8. Department of Surgery, Gustave Roussy, University of Paris Sud, Villejuif, France. 9. Centre Léon Bérard, Lyon, France. 10. Department of Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France. Electronic address: catherine.lhomme@igr.fr.
Abstract
BACKGROUND: Patients with high-risk gestational trophoblastic neoplasia (GTN) need multi-agent chemotherapy to be cured. The most common regimen is etoposide (E), methotrexate (M) and actinomycin D (A), alternating weekly with cyclophosphamide (C) plus vincristine (O) (EMA/CO). Cisplatin (P) is a very active drug, but it is usually restricted to second-line therapies. Herein, we report the results of a cisplatin-based therapy: APE (actinomycin D, cisplatin, and etoposide). PATIENTS AND METHODS: The efficacy and safety of APE for high-risk GTN (defined by Institut Gustave-Roussy (IGR) criteria and/or an International Federation of Gynaecology and Obstetrics (FIGO) score >6) are reported. Patients with brain metastasis or placental-site trophoblastic tumour were excluded. RESULTS: Between 1985 and 2013, 95 patients were treated with APE for high-risk GTN: 59 patients as first-line, 36 as ⩾ 2nd-line therapy. There was 94.7% complete remission, though five patients relapsed. One patient died from GTN after multiple lines of chemotherapy. The five-year overall survival rate (median follow-up 5.7 years) was 97% (95% confidence interval (CI): 91-99%). No death from toxicity occurred. Long-term, six grade-1 neuro-toxicities, three grade-1 and two grade-2 oto-toxicities, and one grade-1 renal toxicity were recorded. One patient developed AML-M4 after APE and EMA/CO. Thirty-four of 35 women, who wished to become pregnant, succeeded and all had at least one live birth. CONCLUSION: With a 97% long-term overall survival rate, limited long-term toxicity, and an excellent reproductive outcome, APE could be regarded as an alternative option to EMA/CO as a standard therapy for high-risk GTN.
BACKGROUND:Patients with high-risk gestational trophoblastic neoplasia (GTN) need multi-agent chemotherapy to be cured. The most common regimen is etoposide (E), methotrexate (M) and actinomycin D (A), alternating weekly with cyclophosphamide (C) plus vincristine (O) (EMA/CO). Cisplatin (P) is a very active drug, but it is usually restricted to second-line therapies. Herein, we report the results of a cisplatin-based therapy: APE (actinomycin D, cisplatin, and etoposide). PATIENTS AND METHODS: The efficacy and safety of APE for high-risk GTN (defined by Institut Gustave-Roussy (IGR) criteria and/or an International Federation of Gynaecology and Obstetrics (FIGO) score >6) are reported. Patients with brain metastasis or placental-site trophoblastic tumour were excluded. RESULTS: Between 1985 and 2013, 95 patients were treated with APE for high-risk GTN: 59 patients as first-line, 36 as ⩾ 2nd-line therapy. There was 94.7% complete remission, though five patients relapsed. One patient died from GTN after multiple lines of chemotherapy. The five-year overall survival rate (median follow-up 5.7 years) was 97% (95% confidence interval (CI): 91-99%). No death from toxicity occurred. Long-term, six grade-1 neuro-toxicities, three grade-1 and two grade-2 oto-toxicities, and one grade-1 renal toxicity were recorded. One patient developed AML-M4 after APE and EMA/CO. Thirty-four of 35 women, who wished to become pregnant, succeeded and all had at least one live birth. CONCLUSION: With a 97% long-term overall survival rate, limited long-term toxicity, and an excellent reproductive outcome, APE could be regarded as an alternative option to EMA/CO as a standard therapy for high-risk GTN.
Authors: Ignace Nzayisenga; Roanne Segal; Natalie Pritchett; Mary J Xu; Paul H Park; Edgie V Mpanumusingo; Denis G Umuhizi; Donald P Goldstein; Ross S Berkowitz; Vedaste Hategekimana; Clemence Muhayimana; Fidel Rubagumya; Temidayo Fadelu; Neo Tapela; Tharcisse Mpunga; Rahel G Ghebre Journal: J Glob Oncol Date: 2016-04-13