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First‐line treatment with anti‐cancer drugs for low risk gestational trophoblastic neoplasia

Gestational trophoblastic neoplasia (GTN) is a rare but curable disease whereby a malignant tumour develops in the womb after a normal or molar pregnancy (where tissue develops in the womb instead of a baby). Women with GTN are classified as having low‐ or high‐risk GTN using a specific scoring system. Virtually all women with low‐risk GTN are cured by treatment with chemotherapy (anti‐cancer drugs) after undergoing dilatation and curettage (D&C) of the womb. Methotrexate and dactinomycin are the two most commonly used drugs for first‐line treatment of low‐risk GTN, although methotrexate is favoured in Europe and North America. Sometimes the first‐line treatment fails to cure the disease or has side‐effects that require it be discontinued, and a secondary treatment has to be used. If methotrexate is the first drug used, dactinomycin is usually the secondary treatment, and vice versa. We undertook this review as it was not clear which drug, if any, was more likely to cure low‐risk disease in the first instance. Furthermore, it was not clear which, if any, caused more side‐effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Anti‐cancer drug treatment for gestational trophoblastic neoplasia (GTN) that does not respond to first‐line treatment or that re‐occurs

This review concerns anti‐cancer drug treatment for women with GTN that does not respond to first‐line treatment or that re‐occurs. GTN is the name given to a type of cancer that arises from placental tissue following pregnancy, most frequently a molar pregnancy. Molar pregnancies are benign abnormal growths of placental tissue inside the womb. Most are cured by evacuation (D&C) of the womb, however, in up to 20% of cases they become malignant. GTN is usually very responsive to anti‐cancer drugs (chemotherapy), however, these drugs can be toxic, therefore the aim of treatment is to achieve a cure with the least side effects. To help doctors select the most appropriate treatment for women with GTN, the disease is classified as low‐ or high‐risk according to specific risk factors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Prophylactic (preventive) chemotherapy for hydatidiform mole (molar pregnancy) to prevent cancerous growth later

A molar pregnancy (hydatidiform mole) develops following an abnormal process of conception, whereby placental tissue overgrows inside the womb (uterus). Molar pregnancies are classified as complete (CM) or partial (PM) based on their appearance (gross and microscopic), and their chromosome pattern. Moles are usually suspected at the early pregnancy scan and women often present with bleeding, similar to a miscarriage. The molar tissue is removed by evacuation of retained products of conception (ERPC), also known as dilatation and curettage (D&C) and women generally make a full recovery. However, some women go on to develop a cancer in the womb (about 1 in every 5 women with a CM and 1 in 200 with a PM). Women are generally at a higher risk of getting this cancer, which is known as gestational trophoblastic neoplasia (GTN), if they are over 40 years old, have a large increase in the size of the womb, have large cysts in the ovaries or have high initial levels of β‐human chorionic gonadotrophin (hCG) (the pregnancy hormone) in their blood. Although treatment of the cancer with chemotherapy (anti‐cancer drugs) is almost always effective, it has been suggested that routinely giving women anti‐cancer drugs (P‐Chem) before or after the removal the molar tissue may reduce the risk of the cancerous tissue developing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: November 7, 2014

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