Dados do Trabalho

Título

COMPARATIVE ANALYSIS OF CHEMOTHERAPEUTIC AGENTS IN THE TREATMENT OF LOW-RISK GESTATIONAL TROPHOBLASTIC NEOPLASIA

Introdução

Gestational trophoblastic neoplasia (GTN) is a rare malignant disease that can develop after a molar or non-molar pregnancy and it is diagnosed by the abnormal regression curve of β-hCG. Patients with low-risk GTN obtain a risk score < 7, according to the World Health Organization risk score, as used by the International Federation of Gynecology and Obstetrics (FIGO). Although methotrexate and actinomycin D are effective chemotherapeutics, there is no consensus regarding the drug of first choice.

Objetivo

To compare the efficacy and safety of methotrexate and actinomycin D in the treatment of low-risk GTN.

Método

This is a literature review with a search for clinical studies published in the last 5 years in the English language and available on the PubMed platform. The searches were made by using the key words: “gestational trophoblastic neoplasia”, “methotrexate” and “actinomycin D”.

Resultado

3 randomized clinical trials and 4 retrospective cohort studies were selected. Lawrie et al. (2016) noted that actinomycin D is more likely to achieve primary cure, with less likelihood of resulting in therapeutic failure. Methotrexate regimens were associated with more cases of mucositis, tearing and dry eye, while alopecia was more reported in actinomycin D regimens. In the retrospective study by Lee et al. (2016), biweekly actinomycin D regimens were shown to be a better option than methotrexate, with minimal levels of hepatotoxicity. According to Alobaid et al. (2019), the mean risk score for patients experiencing treatment failure with methotrexate was 5, while the score was 2 for those who responded completely, which may suggest that patients with a better prognosis show better response to methotrexate. Two retrospective studies by Hoeijmakers et al. (2020) identified high-risk predictive factors for actinomycin D resistance: presence of invasive uterine lesions observed by transvaginal ultrasonography and levels of β-hCG levels ≥ 4000 IU/L before treatment initiation.

Conclusão

Although the frequency of adverse effects was higher in the use of methotrexate, there was no evidence of impairment in quality of life and this agent has a higher remission rate in cases with a better prognosis. Actinomycin D therapy is recommended for patients who have contraindications for the use of methotrexate, such as in chronic liver disease, or who have failed primary chemotherapy with this agent, which was observed to be indicative of higher risk score GTN.

Palavras-chave

Gestational Trophoblastic Disease. Methotrexate. Actinomycin D.