Gestational trophoblastic neoplasia: one size does not fit all – Authors' reply

We thank Eduardo Paulino for his interest in our Article 1 Braga A Paiva G Ghorani E et al. Predictors for single-agent resistance in FIGO score 5 or 6 gestational trophoblastic neoplasia: a multicentre, retrospective, cohort study. Lancet Oncol. 2021; 22: 1188-1198 Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar and take the opportunity to respond to his comments. A remission rate of 80% with dactinomycin after methotrexate chemoresistance for gestational trophoblastic neoplasia treatment cannot be expected among patients with gestational trophoblastic neoplasia who have an International Federation of Gynaecology and Obstetrics (FIGO) risk score of 5 or 6. Sita-Lumsden and colleagues showed that 26 (44%) of 59 patients with a FIGO score of 5 or 6 could attain remission with one or two sequential single agents (eg, methotrexate with or without dactinomycin). 2 Sita-Lumsden A Short D Lindsay I et al. Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000–2009. Br J Cancer. 2012; 107: 1810-1814 Crossref PubMed Scopus (88) Google Scholar Predictors for single-agent resistance in FIGO score 5 or 6 gestational trophoblastic neoplasia: a multicentre, retrospective, cohort studyApproximately 60% of women with gestational trophoblastic neoplasia presenting with a FIGO risk score of 5 or 6 achieve remission with single-agent therapy; almost all remaining patients have complete remission with subsequent multiagent chemotherapy. Primary multiagent chemotherapy should only be given to patients with metastatic disease and choriocarcinoma, regardless of pretreatment human chorionic gonadotropin concentration, or to those defined by our new predictors. Full-Text PDF Gestational trophoblastic neoplasia: one size does not fit allGestational trophoblastic neoplasia is a rare disease that appears in placental tissue with a high remission rate when treated correctly. Treatment is based on the International Federation of Gynaecology and Obstetrics and WHO scoring system.1 Patients with low-risk disease usually receive single-agent chemotherapy (most often methotrexate or dactinomycin) and, in resistant disease, consecutive single agents can give high rates of complete remission. Antonio Braga and colleagues attempted to identify patients who were likely to benefit from multiagent chemotherapy (ie, score 5 or 6), because some centres offer multiagent chemotherapy as the preferred front-line regimen, resulting in overtreatment. Full-Text PDF