The Experts below are selected from a list of 267 Experts worldwide ranked by ideXlab platform
Willian Simoes Clagnan - One of the best experts on this subject based on the ideXlab platform.
-
treatment for low risk gestational trophoblastic disease comparison of single agent methotrexate Dactinomycin and combination regimens
Obstetrical & Gynecological Survey, 2008Co-Authors: Renato Antonio Abrao, Jurandyr Moreira De Andrade, Daniel Guimaraes Tiezzi, Heitor Ricardo Cosiski Marana, Francisco Jose Candido Dos Reis, Willian Simoes ClagnanAbstract:Numerous chemotherapy regimens for treating gestational trophoblastic disease (GTD) have been described over the past 5 decades. Few studies have evaluated different chemotherapeutic agents in patients from a single center who had low-risk GTD. This retrospective review, covering the years 1980-2002, compared 3 medication regimens in 108 patients who had low-risk but persistent GTD and who received first-line chemotherapy. Forty-two patients were treated with methotrexate (MTX), 42 with Dactinomycin (ACT), and 24 with a combination of MTX and ACT (MACT). Rates of complete remission were 69% in the MTX group, 61.4% in patients treated with ACT, and 79.1% in those given combination therapy. There were no significant group differences in either the duration of treatment or the number of courses of chemotherapy. Reported rates of adverse side effects were 62.5% in the MACT group, 28.6% with MTX only, and 19.1% in patients given only ACT. Grade 3 or grade 4 side effects were recorded in 2 patients in the MTX group and 2 of those given combined treatment. Hysterectomy was done in 21 patients, with no differences among treatment groups. Thirty patients required second-line chemotherapy. The investigators conclude that single-agent chemotherapy is as effective as combination chemotherapy when treating patients for low-risk GTD. Dactinomcin was the least toxic of the drugs evaluated in this study, and it might be the most cost-effective option. In areas where resources are limited, MTX-which is relatively feasible to administer-is the preferred regimen.
-
treatment for low risk gestational trophoblastic disease comparison of single agent methotrexate Dactinomycin and combination regimens
Gynecologic Oncology, 2008Co-Authors: Renato Antonio Abrao, Jurandyr Moreira De Andrade, Daniel Guimaraes Tiezzi, Heitor Ricardo Cosiski Marana, Francisco Jose Candido Dos Reis, Willian Simoes ClagnanAbstract:Abstract Objectives To compare the efficacy of three different standard chemotherapy regimens for low-risk gestational trophoblastic disease according to the FIGO staging system in a single-institute setting. Methods From 1980 until 2002, we retrospectively reviewed 108 cases with low-risk persistent gestational trophoblastic disease who were treated with first-line chemotherapy. Patients were divided in three groups according to chemotherapy regimen: patients treated with methotrexate (MTX group; n =42), patients treated with Dactinomycin (ACT group; n =42) and patients treated with methotrexate and Dactinomycin in combination (MACT group; n =24). We compared the number of chemotherapy courses for achieving remission, the duration of treatment, the adverse side effects, the efficacy of the treatment and the need for performing a hysterectomy among the groups Results The complete remission rates were 69%, 61.4% and 79.1% for methotrexate (MTX), Dactinomycin (ACT) and the combination regimen (MACT) treated groups, respectively ( p =0.7). The duration of the treatment and the number of chemotherapy courses were similar among the groups ( p =0.2 and p =0.4, respectively). Adverse side effects rate was reported to be 62.5% in the MACT group, 28.6% in the MTX group and 19.1% in the ACT group ( p =0.0003). Second-line chemotherapy was indicated for 30 patients. Hysterectomy was performed in 21 patients overall, and there was no difference among the groups ( p =0.6). Conclusion Our analysis indicates that single-agent chemotherapy regimens are as effective as combination chemotherapy for low-risk gestational trophoblastic disease. Dactinomycin is a less toxic drug and might offer the best cost-effective treatment option. Methotrexate must be considered as the regimen of choice for low resource areas because of the feasibility of its administration.
Renato Antonio Abrao - One of the best experts on this subject based on the ideXlab platform.
-
treatment for low risk gestational trophoblastic disease comparison of single agent methotrexate Dactinomycin and combination regimens
Obstetrical & Gynecological Survey, 2008Co-Authors: Renato Antonio Abrao, Jurandyr Moreira De Andrade, Daniel Guimaraes Tiezzi, Heitor Ricardo Cosiski Marana, Francisco Jose Candido Dos Reis, Willian Simoes ClagnanAbstract:Numerous chemotherapy regimens for treating gestational trophoblastic disease (GTD) have been described over the past 5 decades. Few studies have evaluated different chemotherapeutic agents in patients from a single center who had low-risk GTD. This retrospective review, covering the years 1980-2002, compared 3 medication regimens in 108 patients who had low-risk but persistent GTD and who received first-line chemotherapy. Forty-two patients were treated with methotrexate (MTX), 42 with Dactinomycin (ACT), and 24 with a combination of MTX and ACT (MACT). Rates of complete remission were 69% in the MTX group, 61.4% in patients treated with ACT, and 79.1% in those given combination therapy. There were no significant group differences in either the duration of treatment or the number of courses of chemotherapy. Reported rates of adverse side effects were 62.5% in the MACT group, 28.6% with MTX only, and 19.1% in patients given only ACT. Grade 3 or grade 4 side effects were recorded in 2 patients in the MTX group and 2 of those given combined treatment. Hysterectomy was done in 21 patients, with no differences among treatment groups. Thirty patients required second-line chemotherapy. The investigators conclude that single-agent chemotherapy is as effective as combination chemotherapy when treating patients for low-risk GTD. Dactinomcin was the least toxic of the drugs evaluated in this study, and it might be the most cost-effective option. In areas where resources are limited, MTX-which is relatively feasible to administer-is the preferred regimen.
-
treatment for low risk gestational trophoblastic disease comparison of single agent methotrexate Dactinomycin and combination regimens
Gynecologic Oncology, 2008Co-Authors: Renato Antonio Abrao, Jurandyr Moreira De Andrade, Daniel Guimaraes Tiezzi, Heitor Ricardo Cosiski Marana, Francisco Jose Candido Dos Reis, Willian Simoes ClagnanAbstract:Abstract Objectives To compare the efficacy of three different standard chemotherapy regimens for low-risk gestational trophoblastic disease according to the FIGO staging system in a single-institute setting. Methods From 1980 until 2002, we retrospectively reviewed 108 cases with low-risk persistent gestational trophoblastic disease who were treated with first-line chemotherapy. Patients were divided in three groups according to chemotherapy regimen: patients treated with methotrexate (MTX group; n =42), patients treated with Dactinomycin (ACT group; n =42) and patients treated with methotrexate and Dactinomycin in combination (MACT group; n =24). We compared the number of chemotherapy courses for achieving remission, the duration of treatment, the adverse side effects, the efficacy of the treatment and the need for performing a hysterectomy among the groups Results The complete remission rates were 69%, 61.4% and 79.1% for methotrexate (MTX), Dactinomycin (ACT) and the combination regimen (MACT) treated groups, respectively ( p =0.7). The duration of the treatment and the number of chemotherapy courses were similar among the groups ( p =0.2 and p =0.4, respectively). Adverse side effects rate was reported to be 62.5% in the MACT group, 28.6% in the MTX group and 19.1% in the ACT group ( p =0.0003). Second-line chemotherapy was indicated for 30 patients. Hysterectomy was performed in 21 patients overall, and there was no difference among the groups ( p =0.6). Conclusion Our analysis indicates that single-agent chemotherapy regimens are as effective as combination chemotherapy for low-risk gestational trophoblastic disease. Dactinomycin is a less toxic drug and might offer the best cost-effective treatment option. Methotrexate must be considered as the regimen of choice for low resource areas because of the feasibility of its administration.
S D Costa - One of the best experts on this subject based on the ideXlab platform.
-
methotrexate monotherapy for high risk gestational trophoblastic neoplasia after therapy with etoposide methotrexate and Dactinomycin a case report
American Journal of Obstetrics and Gynecology, 2008Co-Authors: A Taran, Atanas Ignatov, Bobbie Smith, Joachim Bischoff, S D CostaAbstract:We present a case of high-risk metastatic gestational trophoblastic neoplasia treated successfully with methotrexate monotherapy after severe toxicity from the combination chemotherapy: etoposide, Dactinomycin, methotrexate, vincristine, and cyclophosphamide.
Alon D Altman - One of the best experts on this subject based on the ideXlab platform.
-
low risk gestational trophoblastic neoplasia in manitoba experience with alternating methotrexate and Dactinomycin
International Journal of Gynecological Cancer, 2018Co-Authors: Vanessa Carlson, Leslea Walters, Pascal Lambert, Erin Dean, Robert Lotocki, Alon D AltmanAbstract:Objectives The aim of this study was to review the treatment and outcomes of low-risk gestational trophoblastic neoplasia (GTN) in Manitoba over more than 3 decades, with a focus on those treated with alternating methotrexate and Dactinomycin, a protocol that has only rarely been described. Materials and Methods We retrospectively reviewed all patients with GTN referred to CancerCare Manitoba from January 1977 to December 2012. Cases were classified as low risk as per the modified WHO-FIGO prognostic scoring system (score, ⩽6). Demographic, treatment, and outcomes data were abstracted, and descriptive statistics and time-to-event analysis were performed. The low-risk protocol used at CancerCare Manitoba consists of alternating single-agent use of methotrexate and Dactinomycin, each for 5 days, on a 14-day cycle. Results Sixty-seven cases of GTN were identified, of which 52 were low risk. Thirty-nine patients were initiated on alternating methotrexate and Dactinomycin. Thirty-four (87.2%) achieved primary cure on this regimen, with a median of 4.4 cycles administered (range, 2–7). Median time to response was 56 days. One patient achieved cure after receiving a repeat course of methotrexate as their final cycle. Second-line multiagent chemotherapy was required by 4 patients. Two patients experienced grade 3 toxicities, and none greater than grade 3. There were no recurrences. Conclusions Alternating methotrexate and Dactinomycin is an effective treatment protocol for low-risk GTN, with high rates of primary cure and acceptable toxicity.
Ernest I Kohorn - One of the best experts on this subject based on the ideXlab platform.
-
is lack of response to single agent chemotherapy in gestational trophoblastic disease associated with dose scheduling or chemotherapy resistance
Gynecologic Oncology, 2002Co-Authors: Ernest I KohornAbstract:Abstract Objective. The aim of this study was to determine whether in the management of low-risk gestational trophoblastic neoplasia (GTN) the administration of 5-day courses of 12 μg/kg actinomycin D is effective following the failure of 1.25 mg/m 2 "pulsed" actinomycin D. Methods. Patients with low-risk GTN who failed to respond to 1.25 mg/m 2 pulsed actinomycin were switched to the 5-day course of 12 μg/kg actinomycin. Results. Patients with low-risk GTN who failed to respond to pulsed actinomycin were changed to the same chemotherapy agent, actinomycin D, given as a 5-day course at 12 μg/kg. Four of the five responded and one required methotrexate to achieve remission. Conclusions. Pulsed biweekly actinomycin and pulsed weekly methotrexate have been shown to have a higher failure rate than the 5-day regimens of the same medications. This study demonstrates that failure of pulsed actinomycin may be successfully treated by a 5-day course of the same medication. It appears that with the pulsed regimens cytotoxic exposure of trophoblastic cells to the medication is too brief and the 5-day course permits more cells to be in cycle. It is suggested that, following failure of a pulsed regimen, the patient is given the same chemotherapy as a 5-day course, rather than switching from actinomycin to methotrexate or vice versa. This conserves options for chemotherapy in GTN.
