Cioffi R, et al. - Researchers here analyzed menstrual and reproductive outcomes of women treated with single-agent vs multiagent chemotherapy for gestational trophoblastic neoplasia. Observations revealed a rare adverse effect of combined treatments ie the risk of premature ovarian failure. Except for this, both single-agent and multiagent chemotherapy could be safely administered to patients with a desire for childbearing. Compared to low-risk patients, high-risk patients have worse reproductive outcomes because they undergo hysterectomy more frequently.

Methods

• Researchers identified 151 patients who were treated.
• They excluded 76 patients older than 45 years, with a placental site or epithelioid trophoblastic tumor, undergoing hysterectomy for patient choice, or undergoing human chorionic gonadotropin follow-up at the time of the analysis.
• According to International Federation of Gynecology and Obstetrics score, they divided 75 patients into subgroups: patients scoring less than 7, receiving single-agent chemotherapy (group A, n = 42); patients scoring 7 or greater, receiving combination treatment (group B, n = 33). Patients' outcomes were compared by univariate and multivariate analyses.

Results

• In 33% of group A patients and 66.7% of group B (P=0.01), temporary amenorrhea occurred.
• Three patients in group B showed premature menopause (0% vs 9%, P=0.02).
• Salvage hysterectomy was performed on 10 patients in group B.
• The 2 groups did not differ regarding pregnancy desire (P = 0.555).
• Researchers observed that 57.1% in group A and 36.4% in group B became pregnant (P=0.060).
• Instead, among high-risk patients not undergoing hysterectomy, pregnancy rate was 52.2% (57.1% vs 52.2%, P=0.449).
• They noticed no difference in miscarriage (P = 0.479) and premature birth (P = 0.615) rates.
• A multivariate analysis including age, International Federation of Gynecology and Obstetrics score, chemotherapy type, use of assisted reproductive technologies, previous pregnancies, and pregnancy desire revealed that only age (P=0.006) and pregnancy desire (P=0.002) had a significant impact on the probability to have subsequent pregnancies.