PMID- 29203174
OWN - NLM
STAT- MEDLINE
DCOM- 20180702
LR  - 20220409
IS  - 1095-6859 (Electronic)
IS  - 0090-8258 (Linking)
VI  - 148
IP  - 2
DP  - 2018 Feb
TI  - The efficacy and safety of first-line single-agent chemotherapy regimens in 
      low-risk gestational trophoblastic neoplasia: A network meta-analysis.
PG  - 247-253
LID - S0090-8258(17)31541-X [pii]
LID - 10.1016/j.ygyno.2017.11.031 [doi]
AB  - OBJECTIVE: There is no consensus regarding what should be the optimal 
      single-agent regimen in low-risk gestational trophoblastic neoplasia(LRGTN). we 
      performed this network meta-analysis(NMA) and our aim is to synthesize all 
      efficacy evidence, enabling a comparison of all single-agent 
      methotrexate(MTX)-based or actinomycin-d(Act-D)-based regimens in LRGTN. METHODS: 
      We performed a literature search of PubMed, Embase, and the Cochrane Library for 
      all relevant articles. Seven randomized controlled trials and four retrospective 
      studies met the study eligibility criteria. Overall, 987 patients were included. 
      Treatments were grouped into weekly intramuscular MTX(w-IM MTX), five-day 
      intramuscular MTX(5d-IM MTX), five-day intravenous MTX(5d-IV MTX), eight-day 
      intramuscular MTX with folinic acid(MTX-FA), five-day intravenous Act-D(5d-IV 
      Act-D), and bi-weekly pulsed intravenous Act-D (pulsed IV Act-D) treatments. 
      P-score was used to rank the treatments. RESULTS: Values of P-score indicated 
      that the Act-D-based regimens had superior efficacy compared with the MTX-based 
      regimens. Namely, 5d-IV Act-D had the highest probability of being the best 
      treatment arm for CR, followed by pulsed IV Act-D and 5d-IV MTX. Similar results 
      were observed in the subgroup analysis from the prospective studies. Toxicity 
      analysis indicated that 5d-IM MTX showed increased toxicity in nausea and 
      vomiting, as measured by their P-scores. In contrast, 5d-IV Act-D had the highest 
      probability of being the least toxic regimen in terms of nausea and vomiting. 
      Grade 3/4 adverse events (AEs), though infrequent, were more frequently observed 
      in 5d-IM MTX, followed by 5d-IV Act-D and 5d-IV MTX. CONCLUSIONS: Our NMA 
      provides a systematic evaluation of the relative efficacy of available 
      single-agent MTX-based and Act-D-based regimes in LRGTN. Until new evidence 
      becomes available, 5d-IV Act-D and pulsed IV Act-D appear to be the best 
      treatment options in LRGTN.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Li, Jun
AU  - Li J
AD  - Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai 
      Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 
      China.
FAU - Li, Shufen
AU  - Li S
AD  - State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, 
      Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er 
      Rd., Shanghai, China.
FAU - Yu, Hinlin
AU  - Yu H
AD  - Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai 
      Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 
      China.
FAU - Wang, Jieyu
AU  - Wang J
AD  - Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai 
      Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 
      China.
FAU - Xu, Congjian
AU  - Xu C
AD  - Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai 
      Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 
      China.
FAU - Lu, Xin
AU  - Lu X
AD  - Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Shanghai 
      Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 
      China. Electronic address: 052108365@fudan.edu.cn.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20171206
PL  - United States
TA  - Gynecol Oncol
JT  - Gynecologic oncology
JID - 0365304
RN  - 0 (Antineoplastic Agents)
RN  - 1CC1JFE158 (Dactinomycin)
RN  - 935E97BOY8 (Folic Acid)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Antineoplastic Agents/*administration & dosage/adverse effects
MH  - Dactinomycin/administration & dosage/adverse effects
MH  - Drug Administration Schedule
MH  - Female
MH  - Folic Acid/administration & dosage/adverse effects
MH  - Gestational Trophoblastic Disease/*drug therapy
MH  - Humans
MH  - Infusions, Intravenous
MH  - Injections, Intramuscular
MH  - Methotrexate/administration & dosage/adverse effects
MH  - Nausea/chemically induced
MH  - Pregnancy
MH  - Randomized Controlled Trials as Topic
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Vomiting/chemically induced
OTO - NOTNLM
OT  - Chemotherapy
OT  - Gestational trophoblastic neoplasia
OT  - Low risk
OT  - Network meta-analysis
EDAT- 2017/12/06 06:00
MHDA- 2018/07/03 06:00
CRDT- 2017/12/06 06:00
PHST- 2017/09/10 00:00 [received]
PHST- 2017/11/18 00:00 [revised]
PHST- 2017/11/24 00:00 [accepted]
PHST- 2017/12/06 06:00 [pubmed]
PHST- 2018/07/03 06:00 [medline]
PHST- 2017/12/06 06:00 [entrez]
AID - S0090-8258(17)31541-X [pii]
AID - 10.1016/j.ygyno.2017.11.031 [doi]
PST - ppublish
SO  - Gynecol Oncol. 2018 Feb;148(2):247-253. doi: 10.1016/j.ygyno.2017.11.031. Epub 
      2017 Dec 6.