Comparing cisplatin-based combination chemotherapy with EMA/CO chemotherapy for the treatment of high risk gestational trophoblastic neoplasia
Comparing cisplatin-based combination chemotherapy with EMA/CO chemotherapy for the treatment of high risk gestational trophoblastic neoplasia
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DOI：
10.1016/j.ejca.2012.09.015
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发表时间：
2013-03-01
影响因子：
8.4
通讯作者：
Ottevanger, P. B.
中科院分区：
文献类型：
--
作者：
Lybol, C.;Thomas, C. M. G.;Ottevanger, P. B.
背景资料：顺铂为基础的化疗（依托泊苷100 mg/m2第1-5天，甲氨蝶呤300 mg/m2第1天，环磷酰胺600 mg/m2第1天，放线菌素D 0.6 mg/m2第2天，顺铂60 mg/m2第4天，EMACP）与EMA/CO（依托泊苷100 mg/m2第1-2天，甲氨蝶呤300 mg/m2第1天，放线菌素D 0.5 mg i. v.推注第1天和0.5 mg/m2第2天，与环磷酰胺600 mg/m2（第8天）和长春新碱1 mg/m2（第8天）交替）用于治疗高危妊娠滋养细胞肿瘤（GTN）。在荷兰，83例患者接受EMACP治疗，103例患者接受EMA/CO治疗。结果指标为缓解率、达到正常人绒毛膜促性腺激素（hCG）浓度的中位疗程数、毒性、复发率和疾病特异性生存率。缓解率相似（EMACP 91.6%，EMA/CO 85.4%）。单药耐药疾病和原发性高风险疾病达到hCG正常化的EMA/CO中位疗程数分别为3和5个疗程，而EMACP为1.5（p = 0.001）和3（p < 0.001）个疗程。与EMACP治疗的患者更经常出现发热，肾毒性，恶心和腹泻的患者相比，EMA/CO治疗的患者。EMA/CO治疗的患者更经常有贫血，神经病变和hepatoxicity.Conclusion：EMACP联合化疗是一种有效的治疗高危GTN，缓解率与EMA/CO。然而，治疗时间的差异仅略短与EMACP。在本研究中，EMACP形式的顺铂化疗未被证明比EMA/CO更有效。（C）2012 Elsevier Ltd.保留所有权利。
Background: Cisplatin-based chemotherapy (etoposide 100 mg/m(2) days 1-5, methotrexate 300 mg/m(2) day 1, cyclophosphamide 600 mg/m(2) day 1, actinomycin D 0.6 mg/m(2) day 2 and cisplatin 60 mg/m(2) day 4, EMACP) was compared to EMA/CO (etoposide 100 mg/m(2) days 1-2, methotrexate 300 mg/m(2) day 1 and actinomycin D 0.5 mg i.v. bolus day 1 and 0.5 mg/m(2) day 2, alternating with cyclophosphamide 600 mg/m(2) day 8 and vincristine 1 mg/m(2) day 8) for the treatment of high-risk gestational trophoblastic neoplasia (GTN).Patients and methods: In the Netherlands, 83 patients were treated with EMACP and 103 patients with EMA/CO. Outcome measures were remission rate, median number of courses to achieve normal human chorionic gonadotrophin (hCG) concentrations, toxicity, recurrent disease rate and disease specific survival.Results: Remission rates were similar (EMACP 91.6%, EMA/CO 85.4%). The median number of courses of EMA/CO to reach hCG normalisation for single-agent resistant disease and primary high-risk disease was three and five courses, respectively, compared to 1.5 (p = 0.001) and three (p < 0.001) courses of EMACP. Patients treated with EMACP more often developed fever, renal toxicity, nausea and diarrhoea compared to patients treated with EMA/CO. Patients treated with EMA/CO more often had anaemia, neuropathy and hepatotoxicity.Conclusion: EMACP combination chemotherapy is an effective treatment for high-risk GTN, with a remission rate comparable to EMA/CO. However, the difference in duration of treatment is only slightly shorter with EMACP. Cisplatin-based chemotherapy in the form of EMACP in this study was not proven more effective than EMA/CO. (C) 2012 Elsevier Ltd. All rights reserved.