Combination methotrexate and gefitinib: A potential medical treatment for inoperable nontubal ectopic pregnancy

摘要

Abstract Nontubal ectopic pregnancies present as a therapeutic challenge. A 35‐year‐old primigravida at 7?weeks gestation had a live interstitial ectopic pregnancy and contraindications to surgery. The patient was treated with a multidose methotrexate regimen combined with oral gefitinib (250?mg daily for 7?days). The peak human chorionic gonadotropin (hCG) of the patient was recorded at 19?510?IU/L and began declining from day 4 of combination therapy (day 6 of initial treatment). Successful resolution of the ectopic was demonstrated by cessation of the fetal heart by day 15 and hCG falling to 23?IU/L by day 42. A 10‐year review of all nontubal ectopic pregnancies treated with methotrexate identified 46 cases, which had a comparable time to resolution to combination therapy. However, for cases where cardiac activity was present, the median time to resolution following methotrexate treatment was 64?days (47–87?days), 22?days longer than combination therapy. Combination therapy may provide a safe medical treatment for inoperable nontubal ectopic pregnancy.