What is the best protocol of single-agent methotrexate chemotherapy in nonmetastatic or low-risk metastatic gestational trophoblastic tumors? A review of the evidence

Gynecologic Oncology
Katy FoulmannAnne-Marie Schott

Abstract

Gestational trophoblastic diseases (GTD), a group of rare placenta disorders, have a varying potential for invasion, either local, or remote under the form of metastases, and are definitely cured by chemotherapy in 85 to 99% of cases. Single-agent methotrexate is the usual primary treatment for women with low-risk trophoblastic tumors (TT), yet various regimens are currently used worldwide. We reviewed these regimens and the available evidence for evaluating their respective efficacy and tolerance. We performed an exhaustive literature search and applied the French agency for evaluation in healthcare (HAS) methodology for critical appraisal and level of evidence. We summarised the protocols used in the selected studies and their respective results regarding efficacy and toxicity. We selected 18 original studies on the efficacy and tolerance of methotrexate used alone or in association with folinic acid for the treatment of nonmetastatic or low-risk metastatic trophoblastic tumors. Among these 18 studies, 15 were retrospective series, 3 were prospective series without any control group, and none were controlled clinical trial. We identified four main chemotherapy regimens and two very different strategies for repeating the treat...Continue Reading

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Citations

Mar 6, 2009·Archives of Gynecology and Obstetrics·Mitra MohitAmir Vasheghani-Farahani
Aug 1, 2012·Gynecologic Oncology·Ross S Berkowitz, Donald Peter Goldstein
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Oct 4, 2015·American Journal of Obstetrics and Gynecology·Pierre-Adrien BolzeFrançois Golfier
Nov 7, 2009·The American Journal of Pathology·Stefanie M UedaIe-Ming Shih
Dec 11, 2014·The Journal of Obstetrics and Gynaecology Research·Azam Sadat MousaviKazem Zendehdel
Apr 28, 2009·American Journal of Obstetrics and Gynecology·Gihad Elias ChalouhiDaniel Raudrant
Oct 15, 2011·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Azamsadat MousaviHadi Shojaei
Jul 28, 2018·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Xiyan MuDanqing Wang
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Jun 27, 2019·American Journal of Physiology. Cell Physiology·Binbin HuangJian Zhang
Sep 14, 2017·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Wael TraboulsiNadia Alfaidy

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