Results with Floxuridine, Actinomycin D, Etoposide, and Vincristine in Gestational Trophoblastic Neoplasias with International Federation of Gynecology and Obstetrics Scores ≥5
Results with Floxuridine, Actinomycin D, Etoposide, and Vincristine in Gestational Trophoblastic Neoplasias with International Federation of Gynecology and Obstetrics Scores ≥5
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DOI：
10.1002/onco.13943
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发表时间：
2021-09-09
期刊：
影响因子：
5.8
通讯作者：
Xiang, Yang
中科院分区：
文献类型：
--
作者：
Li, Yuan;Kong, Yujia;Xiang, Yang
背景中国几十年来，以5-氟尿嘧啶为基础的多药化疗一直被用作高危妊娠滋养细胞肿瘤的主要治疗方法。本研究旨在评价氟尿苷、放线菌素D、依托泊苷和长春新碱(FAEV)作为一线方案治疗国际妇产科联合会(FIGO)评分5分的GTN患者的疗效和毒性。材料与方法2002年1月至2017年12月，北京协和医院以FAEV作为一线化疗方案治疗FIGO评分5分的GTN患者207例。分析完全缓解(CR)、耐药性、存活率、毒性和生殖结局。结果在接受FAEV治疗的207例患者中，9例(4.3%)因毒副反应需改行化疗，1例(0.5%)在治疗5周后死于脑疝。其余197例患者可评估对FAEV的反应，其中168例(85.3%)FAEV获得CR，29例(14.7%)对FAEV产生耐药性。全组5年总生存率为97.4%。3~4级中性粒细胞减少、血小板减少和贫血的发生率分别为28.4%、6.8%和6.2%。没有发生与急性毒性相关的死亡。5名患者在接受化疗10-50个月后发展为急性髓系白血病；另1名患者在完成治疗2年后发展为十二指肠癌。61名保留生育能力的患者希望怀孕；其中56人怀孕。结论FAEV方案是治疗FIGO评分<5分的GTN患者的一种有效的首发治疗方案，且毒性可预测、可控。实践的意义高危妊娠滋养细胞肿瘤(GTN)最常用的多种化疗药物是依托泊苷、甲氨蝶呤、放线菌素D/环磷酰胺和长春新碱(EMA/CO)。然而，以5-氟尿嘧啶为基础的多药化疗在中国几十年来一直被用作高危GTN的主要治疗方法。本研究评估了氟尿嘧啶、放线菌素D、依托泊苷和长春新碱(FAEV)作为国际妇产科联合会(FIGO)评分5分的GTN患者的主要治疗方案的疗效和毒性。研究数据表明，FAEV作为主要治疗方案对FIGO评分为5的患者取得了良好的效果。FAEV方案产生的毒性是可预测和可控的。FAEV方案可能为GTN的治疗提供另一种选择。
Background 5-fluorouracil-based multiagent chemotherapy has been used as the primary treatment for high-risk gestational trophoblastic neoplasia (GTN) in China for a few decades. This study aims to assess the efficacy and toxicity of floxuridine, actinomycin D, etoposide, and vincristine (FAEV) as a primary treatment for patients with GTN who had International Federation of Gynecology and Obstetrics (FIGO) scores >= 5. Materials and Methods A total of 207 patients with GTN who had FIGO scores >= 5 were treated with FAEV as first-line chemotherapy at Peking Union Medical College Hospital between January 2002 and December 2017. Complete remission (CR), resistance, survival, toxicity, and reproductive outcomes were analyzed. Results Of the 207 patients treated with FAEV, 9 (4.3%) required a change of chemotherapy owing to toxicity and 1 (0.5%) died of cerebral hernia 5 weeks after commencing treatment. The remaining 197 patients were assessable to determine the response to FAEV; among them, 168 (85.3%) achieved CR with FAEV and 29 (14.7%) developed resistance to FAEV. The 5-year overall survival rate of the entire cohort was 97.4%. Grade 3-4 neutropenia, thrombocytopenia, and anemia occurred in 28.4%, 6.8%, and 6.2% of cycles, respectively. No acute toxicity-related deaths occurred. Five patients developed acute myeloid leukemia 10-50 months after exposure to chemotherapy; another patient developed duodenal cancer 2 years after completing therapy. Sixty-one patients who preserved fertility wanted to become pregnant; 56 of them conceived. Conclusion The FAEV regimen is an effective primary treatment for patients with GTN who have FIGO scores >= 5 and has predictable and manageable toxicity. Implications for Practice The most commonly used multiagent chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) is etoposide, methotrexate and actinomycin D/cyclophosphamide and vincristine (EMA/CO) worldwide. However, 5-fluorouracil-based multiagent chemotherapy has been used as a primary treatment for high-risk GTN in China for a few decades. This study evaluated the efficacy and toxicity of floxuridine, actinomycin D, etoposide, and vincristine (FAEV) as a primary treatment for patients with GTN who have International Federation of Gynecology and Obstetrics (FIGO) scores >= 5. The study's data demonstrated that FAEV as a primary treatment achieved favorable outcomes for patients with FIGO scores >= 5. Toxicities that result from the FAEV regimen are predictable and manageable. The FAEV regimen may provide another option for the treatment of GTN.