Early identification of treatment resistance in GTN.

摘要

We read with interest the Review by El-Helw and Hancock in a recent issue of The Lancet Oncology, in which the authors highlighted the state of the art of treatment for gestational trophoblastic neoplasia (GTN). Although curable, this disease occurs more often in women wanting to conceive, and any unnecessary delay in treatment and eventual cure will postpone conception. Therefore, we want to stress the importance of early identification of women in whom single-agent chemotherapy is most likely to fail. Patients with GTN are risk stratified according to the International Federation of Gynaecology and Obstetrics (FIGO) staging system, and treatment-ie, single-agent or polychemotherapy-is given accordingly. However, up to 33% of patients treated with single-agent chemotherapy for low-risk GTN will need multiagent chemotherapy because of resistance to the first-line drug or because of side-effects. Regretfully, to date, an internationally accepted definition for resistance to first-line chemotherapy is not available. In some clinics, resistance to first-line chemotherapy is defined as a plateau or rise in serum beta-human chorionic gonadotrophin (hCG) or development of new metastases (or both).