Efficacy Of FAV Regimen And Pulse Act-D Regimen As A First-line Chemotherapy For Low-risk Gestational Trophoblastic Neoplasia

Objective:To investigate and compare the effect of FAV regimen(fluorourea glycoside+actinomycin D+vincristine)and pulse Act-D(actinomycin-D)regimen as a first-line chemotherapy in the treatment of low-risk gestational trophoblastic tumors(GTN).Methods:The clinical data of 295 patients with low-risk GTN.who received FAV or pulse Act-D chemotherapy in Peking Union Medical College Hospital from 2005 to 2017 were retrospectively analyzed,including 15 2 patients in FAV group and 143 patients in Act-D group.Results:Of 295 patients,240(81.4%)patients achieved serological complete remission(SCR)after the first-line chemotherapy with FAV or pulse Act-D regimen,including 132 patients in FAV group and 108 patients in Act-D group(86.8%and 35 cases(9.9%vs 24.5%,p=0.001)were resistant to chemotherapy,and 5 cases and 0 cases(3.2%vs 0%,p=0.029)were changed to other chemotherapy regimens because of intolerance to adverse side effects.Among patients whether resistant or intolerant to chemotherapy regimen,3 cases was lost to follow-up and 1 case was stable disease,the remaining received SCR after changing the chemotherapy regimen.There were 2 recurrences in FAV group and 3 recurrences in Act-D group,respectively(1.3%vs 2.1%,P=0.604).The mean total course of treatment in FAV group and Act-D group was 4.7 and 5.2(p=0.007),the mean course of HCG normalization was 2.5 and 3.3(P=0.000),and the mean consolidation course was 2.2 and 2.0(P=0.088).The mean treatment time length was 10 5 days and 79 days(p=0.000).In subgroup analysis with FIGO score of 0-4.SCR was achieved 86.1%and 76.6%(P=0.051)in FAV group and Act-D group,respectively.The mean total course of treatment in FAV group and Act-D group was 4.5 and 5.2(p=0.000),the mean course to achieve HCG normalization was 2.3 and 3.3(p=0.000),and the mean consolidation course was 2.2 and 2.0(P=0.100),while the mean treatment time length was 101 days and 78 days(P=0.000).The drug resistant rate was 9.8%and 23.4%(p=0.004),and the recurrence rate was 1.6%and 2.1%(p=0.388).In subgroup analysis of GTN after hydatidiform mole,we found more significant difference in SCR rates of FAV group and Act-D group,with 8 8,5%and 75.9%(p=0.010),respectively.While after restricted FIGO score to 0-4,the SCR rates in FAV group and Act-D group were 89.1%and 75.9%(p=0.009).Conclusion:Both FAV and pulse Act-D regimens are effective in the treatment of low-risk GTN.Compared to pulse Act-D regimen,FAV regimen has higher curative ratio and lower drug resistance rate,Additionaly,the difference is more significant in patients with GTN after hydatidiform mole.However,the former regimen demands longer time to cure,and has poorer tolerance than the latter regimen.What's more,In subgroup with FIGO score 0-4,there is no significant difference in the curative ratio between the two regimens,while the regimen of pulse Act-D has higher drug resistance rate,it takes shorter time to treat and has better tolerance.