Table 2.
Retrospective studies of salvage chemotherapy for resistant or relapsed gestational trophoblastic neoplasia
| Authors, Year (Ref) | Primary Therapy | Salvage Therapy | Participants | Outcomes | Toxicity | Remarks |
|---|---|---|---|---|---|---|
| Newland et al. 2000 [47] | EMA-CO | EMA-EP | 34 resistant/ relapsed |
22 Non-assessable (hCG levels approaching normal) 12 Assessable: CR 75 %, OS 88 % |
≥G3 neutropenia 68 % ≥G3 thrombocytopenia 40 % |
|
| Matsui et al. 2002 [48] |
MEA / EMA-CO |
FA | 10 resistant/ relapsed | OS 80 % |
G4 leukocytopenia 6 % G4 thrombocytopenia 4 % |
Mean FU 10 yr 1 had adjuvant surgery |
| Xiang et al. 2004 [49] | N/A | EMA-EP |
12 resistant 3 PSTT |
CR 11/15 (73 %) PR 3/15 (20 %) |
N/A | |
| Ngan et al. 2006 [12] | CHAMOC / MA | MBE |
A: 8 resistant B: 8 relapsed C: 4 ultra-high-risk |
A: CR 88 %, 5-yr DFS 75 % B: CR 88 % C: CR 75 % Overall CR 85 % |
≥G3 neutropenia 12 (60 %) ≥G3 thrombocytopenia 4 (20 %) |
1 had adjuvant surgery 6 had brain radiation 1 had liver radiation |
| Wang et al. 2006 [50] | Various | MEF | 9 resistant/ relapsed |
CR 7/9 (78 %) OS 8/9 (96 %) |
≥G3 neutropenia 26 % ≥G3 thrombocytopenia 5 % |
Mean FU 37 mth |
| Mao et at. 2007 [51] | EMA-CO | EMA-EP |
A: 11 resistant B: 7 relapsed |
A: CR 9/11 (82 %) B: CR 3/7 (43 %) Overall CR 12/18 (67 %) |
≥G3 neutropenia 28 % ≥G3 thrombocytopenia 3 % G3 hepatotixicity 3 % |
8 had adjuvant surgery |
| Wan et al. 2007 [52] | Various | FAEV | 11 resistant | CR 7/11 (64 %) | N/A | |
| Lu et al. 2008 [53] | EMA-CO | EMA -EP |
10 resistant 3 relapsed |
CR 11/13 (85 %) | N/A | 5 had adjuvant surgery / brain radiation |
| Wang et al. 2008 [54] | Various | TP/TE |
A: 16 relapsed (6 with failed cisplatin based regimen) B: 8 toxicities with previous therapy |
A: Response rate 50 %: CR 3 (19 %), PR 5 (31 %) OS 44 % (70 % if 6 with failed cisplatin based regimen excluded) B: CR 2, PR 2, Non-assessable 4 OS 75 % |
≥G3 neutropenia 10 (42 %) ≥G3 thrombocytopenia 3 (13 %) G2 renal toxicity 1 (4 %) Discontinued due to G3 neuropathy 1 (4 %) |
A: Median FU 24 mth B: Median FU 19 mth |
| Zhao et al. 2009 [55] | FA | BEP | 12 resistant | CR 10/12 (83 %) | N/A | |
| Feng et al. 2011 [56] | Various: mainly FAV, EMA-CO, 5-FU | FAEV | 91 resistant/ relapsed |
CR 55/91 (60 %) NR 29/91 (32 %) 3-yr OS 75 % |
≥G3 neutropenia 24 (26.4 %) Febrile neutropenia 6 (6.6 %) ≥G3 thrombocytopenia 3 (3.3 %) Discontinued due to toxicity 7 (7.7 %) |
23 of 55 SCR had adjuvant surgery |
| Lurain et al. 2012 [11] | EMA-CO |
Various: EMA-EP; BEP; VIP; ICE; TP/TE |
28 resistant | CR 82 % | N/A |
11 had adjuvant surgery 4 had brain radiation |
| Manopunya et at. 2012 [57] | Various | FA | 5 resistant (≥3 prior chemotherapy regimens) | CR 1/5 (20 %) |
G4 neutropenia 25 % G3 diarrhoea 8 % G2/3 mucositis 92 % |
EMA-CO: etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine; FA: 5-fluorouracil, actinomycin-D; CHAMOC: cyclophosphamide, hydroxyurea, actinomycin-D, methotrexate with folinic acid and vincristine; MA: methotrexate, actinomycin-D; MEA: methotrexate, etoposide, actinomycin-D; FAV: 5-fluorouracil, actinomycin-D, vincristine; 5-FU: 5-fluorouracil; EMA-EP: etoposide, methotrexate, actinomycin-D, etoposide, cisplatin; EP: etoposide, cisplatin; MEF: methotrexate, etoposide, 5-fluorouracil; BEP: bleomycin, etoposide, cisplatin; VIP: vincristine, ifosfamide, cisplatin; ICE: ifosfamide, cisplatin, etoposide; TP/TE: paclitaxel, cisplatin/paclitaxel, etoposide; MBE: methotrexate, bleomycin, etoposide; FAEV: floxuridine, actinomycin-D, etoposide, vincristine; PSTT: placental site trophoblastic tumour; hCG: human chorionic gonadotrophin; CR: complete response; OS: overall survival; PR: partial response; NR: no response; DFS: disease free survival; N/A: not available; FU: follow-up