The role of low-dose methotrexate and folinic acid in gestational trophoblastic tumours (GTT)

Article Abstract:

A gestational trophoblastic tumor (GTT) is a rare but virulent type of cancer, usually located in the uterus, which is caused by the abnormal growth of placental cells. It can occur after a hydatid mole (a tumor-like mass caused by pregnancy) is formed, miscarriage, or normal pregnancy. The tumor is induced by the hormone estrogen; folic acid antagonists are known to block the growth of estrogen-dependent tumors. Methotrexate, a folic acid antagonist, is a highly toxic chemotherapeutic agent used to treat many cancers. There is a fine line between a therapeutic and toxic dose of methotrexate. Folinic acid, a derivative of folic acid, can be used to counteract the toxic effects of methotrexate during treatment of GTT. The survival of 486 women with GTT who were treated with methotrexate was evaluated. The women were given a score of predicted survival before treatment, and factors influencing prognosis were analyzed. Between 1964 and 1974, 126 patients treated with methotrexate and folinic acid were retrospectively grouped by prognosis. Of these, 85 out of 88 (96 percent) low-risk women were still alive, 20 out of 22 (91 percent) moderate-risk women were still alive, and 5 out of 16 (31 percent) high-risk women survived. Overall, 86 percent of these women with GTT were still alive. The 348 women treated between 1974 and 1986 were classified by risk when they were admitted for treatment. In the low-risk group, 347 out of 348 (99.7 percent) survived. Of the 13 who were at moderate-risk, but were misclassified as low-risk, 12 were still alive (92 percent). The overall survival in this group was 99 percent. Drug resistance developed in 69 out of 348 (20 percent) of the women and drug toxicity occurred in 23 (6 percent) of the subjects. It was concluded that the best regimen for low-risk women is low dose methotrexate-folinic acid treatment, while higher risk women require combination chemotherapy therapy from the onset of illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prognosis, Chemotherapy, Uterine diseases, Leucovorin, Folinic acid, Trophoblastic tumors

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Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989

Article Abstract:

The trophoblast forms the outer layer of the developing embryo and becomes part of the placenta. Gestational trophoblastic tumors (GTT) are tumors that develop from cells that make up the trophoblast, and this type of tumor can occur following any type of pregnancy, miscarriage, or normal delivery. The most common warning signal that a GTT is likely to develop is the presence of a polycystic growth or mass called a hydatidiform mole. This article describes the results of a 10-year study designed to evaluate the effectiveness of chemotherapy in treating patients with GTT. The chemotherapy regimen that was used, called EMA/CO, included a combination of etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine. The study included 148 women at high risk for GTT. Of these patients, 27 had a miscarriage, 53 had a normal full-term delivery, and 68 had a hydatidiform mole. Seventy-six of the patients had not received chemotherapy prior to participating in this study. Following treatment with EMA/CO, the tumors in 82 percent of these patients went into remission. Of the 72 patients who had received chemotherapy prior to treatment with EMA/CO, 89 percent went into remission. The rate of relapse after treatment with EMA/CO was low (5.4 percent). After treatment with EMA/CO was discontinued, menstrual cycles returned to normal and several of the patients went on to have successful pregnancies with no fetal abnormalities. It is concluded that EMA/CO chemotherapy is the treatment of choice for patients with high risk GTT. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chemotherapy, Combination, Combination chemotherapy

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Management of tubal pregnancy with methotrexate

Article Abstract:

Ectopic pregnancies in which embryo implantation takes place outside the uterus, often become as a life threatening illness. Conservative surgical treatment of an ectopic tubal pregnancy is often associated with diminished possibility for subsequent uterine pregnancy. Diagnosis of ectopic pregnancy is confirmed by several tests, including ultrasound, blood levels of human beta chorionic gonadotrophin (HCG) and laparoscope. Methotrexate, a chemotherapeutic drug used in treating certain cancers, was injected directly into the fetal sac in ten ectopic pregnancies. This was followed by intramuscular injections of the drug. Pregnancy termination of the ectopic pregnancy was complete in 8 women over an average of 14.5 days as determined by blood HCG levels. Average hospital stay was 6.4 days. Treatment with methotrexate failed in two patients and one woman had a tubal ligation. The remaining 7 patients (100 percent) maintained intact fallopian tubes. Before methotrexate is used routinely to treat tubal pregnancy, standards for patient selection should be established.

Drug therapy, Pregnancy, Ectopic, Ectopic pregnancy, Pregnancy, Complications of, Pregnancy complications

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