Outcomes of patients registered with the Queensland Trophoblast Centre diagnosed with gestational trophoblastic neoplasia who develop resistance to chemotherapy

Objectives

To audit outcomes of patients registered in the Queensland Trophoblast Centre (QTC) database who develop resistance to primary chemotherapy. To determine any risk factors that may predict first-line chemotherapy resistance in patients diagnosed with gestational trophoblastic neoplasia (GTN).

Methods

Patients within the QTC who were diagnosed with GTN between January 2012 and December 2020 were reviewed.

Results

Of 138 patients with GTN registered in the QTC, 22 (15.9%) patients developed resistance to first-line chemotherapy. Three had high-risk GTN and 19 had low-risk GTN. Of the three high-risk patients, one patient died. This patient had an epithelioid trophoblastic tumour (ETT). The remaining two high-risk patients had complete hydatidiform moles (CHM) with GTN. Both achieved complete remission with salvage therapy. Of the 19 low-risk patients, one patient had a partial hydatidiform mole (PHM). This patient achieved remission following third-line treatment. The other 18 low-risk patients had CHM with GTN. All but two of these 18 patients were successfully treated with second-line chemotherapy, with the remaining two patients achieving remission with third-line chemotherapy. Five of the 18 patients received either actinomycin-D or methotrexate as salvage therapy. Thirteen patients were given multi-agent chemotherapy for second-line treatment. One patient in this group died but this was not due to her disease. Initial β human chorionic gonadotropin levels were not predictive of number of chemotherapy cycles or number of lines of chemotherapy required to achieve remission.

Conclusions

GTN is a curable condition. If resistance to first-line chemotherapy occurred, most patients achieved remission with salvage therapy.