May 20th, 2018

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Role of Capecitabine in the Management of Gestational Trophoblastic Neoplasia: A Drug for Two Settings
Authors:  María Inés Bianconi, M.D., Silvina Otero, M.D., Claudio Storino, M.D., and Gustavo Jankilevich, M.D.
  OBJECTIVE: To evaluate the role of capecitabine in the management of gestational trophoblastic neoplasia (GTN).

STUDY DESIGN: The medical records of 155 patients with GTN were reviewed. All patients were treated and followed at our center.

RESULTS: All patients were scored and stratified with the FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease. In the low-risk group (118 patients), 4 selected patients received capecitabine as second line of treatment, with a 75% response rate and long-term disease-free survival, and 1 of those patients needed EMA/CO to achieve cure. The cure rate was 100%. In the high-risk group 37 patients were reviewed. Capecitabine was indicated after EMA/CO or EMA/PE failure in the second, third, or sixth line. Six patients received capecitabine, with a 50% response rate, and remain as long-term survivors. Two patients who progressed with capecitabine were cured with TP/TE and EMA/PE regimens. One patient was refractory to all lines of chemotherapy.

CONCLUSION: The use of capecitabine avoids multi-ple drug schemes and further toxicity for patients with curative disease, where long-term effects of therapy should be considered a second target. Its convenient oral route of administration and efficacy make capecitabine a drug to be taken into account in future studies of patients with GTN showing progression to standard regimens. Its use as new regimen in these patients must be evaluated. A greater number of cases and ideally a randomized study is needed to confirm our observation.
Keywords:  capecitabine, choriocarcinoma, fluoropyrimidine, gestational trophoblastic disease, gestational trophoblastic neoplasia, hydatidiform mole, xeloda
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