Highlights
- •Low hCG levels before high-dose chemotherapy, a favourable prognostic factor.
- •HDC appears to cure a subset of poor-prognosis placental site/epithelioid trophoblastic tumour patients.
- •HDC can salvage a significant proportion of women with refractory choriocarcinoma.
Abstract
Objective
The objective of the study was to evaluate the effect of high-dose chemotherapy (HDC)
with peripheral blood stem cell support (PBSCS) on survival of patients with gestational
trophoblastic neoplasia (GTN) with either refractory choriocarcinomas or a poor-prognosis
placental site/epithelioid trophoblastic tumours (PSTT/ETTs).
Methods
Databases of two referral centres for gestational trophoblastic disease were searched,
and 32 patients treated with HDC between 1994 and 2015 were identified. Tissue samples
were retrieved for genetic evaluation. Cox regression analyses were performed to identify
possible predictors of overall survival (OS).
Results
HDC induced a sustained complete response in 7 patients. Overall, 41% (13/32) of the
patients remained disease free after HDC with or without additional treatment. Patients
who survived had much lower human chorionic gonadotropin (hCG) values (all ≤12 IU/L)
before and after HDC than those who died of disease. Univariable Cox regression analysis
demonstrated that hCG >12 IU/L before or after HDC, International Federation of Gynaecology
and Obstetrics (FIGO) stage II-IV and presence of metastases at the time of diagnosis
were significantly associated with adverse OS. However, only hCG values before HDC
remained significant in a multivariable model (p < 0.001). Five of 11 (45%) patients with PSTT/ETT presenting ≥48 months after antecedent
pregnancy and 6 of 14 (43%) patients with refractory choriocarcinoma were in remission.
Three treatment-related deaths occurred.
Conclusions
Despite 3 treatment-induced deaths, HDC with PBSCS appears to be active in salvaging
selected patients with poor-prognosis PSTT/ETTs and refractory choriocarcinomas. Low
hCG values before HDC seems a beneficial predictor of OS and may suggest that HDC
acts more like a consolidation therapy.
Keywords
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Article info
Publication history
Published online: February 04, 2019
Accepted:
December 23,
2018
Received in revised form:
December 13,
2018
Received:
August 27,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.