Highlights
- •In multivariate analysis, EMA had similar efficacy to EMACO for the treatment of GTN.
- •Time to remission for EMA and EMACO was similar.
- •Patients receiving EMA experienced greater toxicity, but this likely stemmed from lower rates of growth factor support.
Abstract
Objective
To compare experiences with EMA versus EMACO in the treatment of gestational trophoblastic
neoplasia.
Methods
The medical records of women diagnosed with GTN at the New England Trophoblastic Disease
Center from 1986 to 2019 were reviewed, and women receiving EMA or EMACO as their
first multiagent regimen were eligible. Clinical characteristics, treatment, outcomes,
and adverse events were compared between the two groups.
Results
We identified 44 and 39 patients who received EMA and EMACO, respectively. The complete
remission rate was significantly higher in the EMA group (97.7%) than in the EMACO
group (71.8%) (p = 0.001). However, patients receiving EMACO were more likely to have adverse prognostic
factors such as higher median prognostic risk score (8 vs 4, p < 0.001), non-molar antecedent pregnancy (59 vs 27.3%, p = 0.014) and distant metastasis (64.1 vs 47.7%, p = 0.017). Time to complete remission was also similar (p = 0.947) with a median of 12 weeks with EMA and 13.1 weeks with EMACO. There was
no significant difference in treatment delays or use of adjuvant surgery. After multivariate
analysis, chemotherapy regimen (EMA or EMACO) did not retain prognostic significance
for remission. Overall toxicities were more frequent in EMA (60.2 vs 32.7%, p < 0.001), especially neutropenia, but this did not delay treatment and likely resulted
from less growth factor support (18.2 vs 48.7%, p = 0.003).
Conclusions
When controlling for other prognostic factors, outcomes with EMA appear similar to
EMACO. It may be worthwhile to investigate whether EMA, a simpler and less costly
regimen, may be as effective as EMACO in the treatment of GTN.
Keywords
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Article info
Publication history
Published online: May 11, 2020
Accepted:
April 23,
2020
Received:
March 4,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
