Chemotherapy

Tahaa – Polynesia

Chemotherapy

SOGC/GOC Clinical Guideline #408, January 2021

  • GOG 174 : Dactinomycin vs. weekly MTX 30.70% vs 53% complete response. These rates are compared to 70.8% for weekly MTX 50 and 69.5% for MTX 8 days in a non-randomized cohort study.
  • The most common side effects are nausea, fatigue, and anemia, with no major difference between the toxicity profiles of methotrexate and dactinomycin. However, alopecia is more common with dactinomycin, while stomatitis is more common with methotrexate.
  • Patients at risk of MTX-resistant disease:
  • Doppler ultrasound reveals a uterine artery pulsatility index of ≤ 1;
  • FIGO prognostic score of 5 or 6;
  • Pre-treatment hCG levels exceeded 400,000 mIU/ml;
  • Non-molar choriocarcinoma;
  • Suboptimal response as revealed by nomograms or kinetic studies of hCG (semi-logarithmic curves).
  • The pulsatility index (Doppler echo) may be an independent predictor of resistance to methotrexate.
  • Although exposure to EMA-CO chemotherapy may lead to early menopause, fertility does not appear to be affected and there is no increase in the risk of congenital malformations.
  • The increased risk of secondary cancer (leukemia, breast cancer, colon cancer, melanoma) highlights the need for long-term follow-up and a centralized registry.

2021. Guideline No. 408: Management of Gestational Trophoblastic Diseases. Eiriksson L, Dean E, Sebastianelli A, Salvador S, Comeau R, Jang JH, Bouchard-Fortier G, Osborne R, Sauthier Ph. J Obstet Gynaecol Can;43(1):91-105.

Modified on 12/23/2023