Risk Factors That Correlate with Resistance to First-Line Chemotherapy on High-risk Gestational Trophoblastic Neoplasia
DOI:
https://doi.org/10.3889/oamjms.2022.9983Keywords:
High-risk gestational trophoblastic neoplasia, EMCO, Chemotherapy resistanceAbstract
BACKGROUND: Gestational trophoblastic neoplasia (GTN) is a condition arising from abnormal proliferation of the trophoblastic cells. GTN incidence in Indonesia, precisely in Hasan Sadikin General Hospital, as many as 730 cases are reported per year. GTN is generally highly sensitive to chemotherapy, and multiagent chemotherapy regimens are recommended for high-risk GTN. Multiagent chemotherapy regimens for GTN treatment at Hasan Sadikin General Hospital are EMCO, with no other literature study describing chemotherapy resistance with EMCO today.
AIM: This study aimed to identify risk factors associated with first-line chemotherapy resistance at Hasan Sadikin General Hospital.
METHODS: In this cross-sectional study, medical records of 81 patients with high-risk GTN presented in the period from January 2018 to June 2021 who received EMCO chemotherapy at Hasan Sadikin General Hospital were retrieved from the archives, and medical data were reviewed and analyzed. Bivariate analysis was performed using the Chi-square test with Fisher’s exact alternative, and multivariate analysis using the binary logistic regression test. p < 0.05 was considered statistically significant.
RESULTS: From 81 samples that received EMCO chemotherapy, 15 (18.5%) cases were resistant to EMCO, and 66 (81.5%) cases were responsive to EMCO. The risk factors associated with EMCO resistance were histopathological features and appropriate with EMCO chemotherapy interval (p < 0.05). Variables of age, previous pregnancy, GTN stage, FIGO prognostic score, stage, beta-hCG level, and side effects of EMCO did not significantly correlate with resistance to EMCO (p > 0.05).
CONCLUSION: Histopathological features and appropriate chemotherapy intervals were associated with the incidence of resistance to EMCO in Hasan Sadikin General Hospital.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Sharami SR, Saffarieh E. A review on management of gestational trophoblastic neoplasia. J Family Med Prim Care. 2020;9(3):1287-95. https://doi.org/10.4103/jfmpc.jfmpc_876_19 PMid:32509606 DOI: https://doi.org/10.4103/jfmpc.jfmpc_876_19
Jareemit N, Horowitz NS, Goldstein DP, Berkowitz RS, Elias KM. EMA vs EMACO in the treatment of gestational trophoblastic neoplasia. Gynecol Oncol. 2020;158(1):99-104. https://doi.org/10.1016/j.ygyno.2020.04.699 PMid:32404247 DOI: https://doi.org/10.1016/j.ygyno.2020.04.699
Raudina F, Hidayat YM, Rachmayati S. Response to chemotherapy in patients with gestational trophoblastic neoplasia in a tertiary hospital in Indonesia. Althea Med J. 2020;7(3):128-35. DOI: https://doi.org/10.15850/amj.v7n3.1894
Anantharaju A, Pallavi VR, Bafna UD, Rathod PS, Vijay CR, Shobha K, et al. Role of salvage therapy in chemo resistant or recurrent high-risk gestational trophoblastic neoplasm. Int J Gynecol Cancer. 2019;29(3):547-53. https://doi.org/10.1136/ijgc-2018-000050 PMid:30700567 DOI: https://doi.org/10.1136/ijgc-2018-000050
Turan T, Karacay O, Tulunay G, Boran N, Koc S, Bozok S, et al. Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy in gestational trophoblastic neoplasia. Int J Gynecol Cancer. 2006;16(3):1432-8. https://doi.org/10.1111/j.1525-1438.2006.00606.x PMid:16803542 DOI: https://doi.org/10.1136/ijgc-00009577-200605000-00074
Alifrangis C, Agarwal R, Short D, Fisher RA, Sebire NJ, Harvey R, et al. EMA/CO for high-risk gestational trophoblastic neoplasia: Good outcomes with induction low-dose etoposide-cisplatin and genetic analysis. J Clin Oncol. 2013;31(2):280-6. https://doi.org/10.1200/JCO.2012.43.1817 PMid:23233709 DOI: https://doi.org/10.1200/JCO.2012.43.1817
Alazzam M, Tidy J, Osborne R, Coleman R, Hancock BW, Lawrie TA. Chemotherapy for resistant or recurrent gestational trophoblastic neoplasia. Cochrane Database Syst Rev. 2012;12:CD008891. https://doi.org/10.1002/14651858.CD008891.pub2 PMid:23235667 DOI: https://doi.org/10.1002/14651858.CD008891.pub2
Kang HJ, Park HJ. Novel molecular mechanism for actinomycin D activity as an oncogenic promoter G-quadruplex binder. Biochemistry. 2009;48(31):7392-8. https://doi.org/10.1021/bi9006836 PMid:19496619 DOI: https://doi.org/10.1021/bi9006836
Kang HL, Zhao Q, Yang SL, Duan W. Efficacy of combination therapy with actinomycin D and methotrexate in the treatment of low-risk gestational trophoblastic neoplasia. Chemotherapy. 2019;64(1):42-7. https://doi.org/10.1159/000500165 PMid:31163446 DOI: https://doi.org/10.1159/000500165
Sinaga RJ, Tobing MD, Harsono AB. Low Risk Gestational Trophoblastic Neoplasia’s Patient Characteristics with chemoresistance to metotrexate in Dr Hasan Sadikin Hospital bandung period 2011-2015. Indones J Obstet Gynecol Sci. 2018;1(2):11-13. https://doi.org/10.24198/obgynia.v1n2.47 DOI: https://doi.org/10.24198/obgynia.v1n2.47
Kim JH, Cha MJ, Kim MK, Chung YJ, Lee EJ. Disseminated primary pulmonary choriocarcinoma successfully treated by chemotherapy: A case report and literature review. Cancer Invest. 2020;38(8-9):493-501. https://doi.org/10.1080/07357907.2020.1804575 PMid:32845165 DOI: https://doi.org/10.1080/07357907.2020.1804575
Sato S, Yamamoto E, Niimi K, Ino K, Nishino K, Suzuki S, et al. The efficacy and toxicity of 4-day chemotherapy with methotrexate, etoposide and actinomycin D in patients with choriocarcinoma and high-risk gestational trophoblastic neoplasia. Int J Clin Oncol. 2020;25(1):203-9. https://doi.org/10.1007/s10147-019-01540-9 PMid:31520175 DOI: https://doi.org/10.1007/s10147-019-01540-9
Matsui H, Suzuka K, Iitsuka Y, Seki K, Sekiya S. Combination chemotherapy with methotrexate, etoposide, and actinomycin D for high-risk gestational trophoblastic tumors. Gynecol Oncol. 2000;78(1):28-31. https://doi.org/10.1006/gyno.2000.5813 PMid:10873405 DOI: https://doi.org/10.1006/gyno.2000.5813
Dobson LS, Lorigan PC, Coleman RE, Hancock BW. Persistent gestational trophoblastic disease: Results of MEA (methotrexate, etoposide and dactinomycin) as first-line chemotherapy in high risk disease and EA (etoposide and dactinomycin) as second-line therapy for low risk disease. Br J Cancer. 2000;82(9):1547-52. https://doi.org/10.1054/bjoc.2000.1176 PMid:10789722 DOI: https://doi.org/10.1054/bjoc.2000.1176
Kim SJ, Bae SN, Kim JH, Kim CJ, Jung JK. Risk factors for the prediction of treatment failure in gestational trophoblastic tumors treated with EMA/CO regimen. Gynecol Oncol. 1998;71(2):247-53. https://doi.org/10.1006/gyno.1998.5161 PMid:9826467 DOI: https://doi.org/10.1006/gyno.1998.5161
Angelina YA, Hartono P. Characteristics of gestational thropoblast tumor in Dr. Soetomo hospital, year 2015-2017. Majalah Obstet Ginekol. 2019;27(2):79-83. https://doi.org/10.20473/mog.V27I22019.79-83 DOI: https://doi.org/10.20473/mog.V27I22019.79-83
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2022 Andi Kurniadi, Zulvayanti Zulvayanti, Dodi Suardi, Kemala Mantilidewi, Bayu Indrayana Irsyad, Arnova Reswari, Benny Hasan Purwara, Gatot Nyarumenteng Adhipurnawan Winarno (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0