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Objective <p>This systematic review and meta-analysis evaluate the efficacy and safety of salvage regimens in managing EMA/CO-resistant GTN, providing evidence to inform optimal treatment strategies.</p> Methods <p>A literature search was conducted in PubMed, ScienceDirect, Cochrane Library, Google Scholar, and Wiley Online Library until December 27, 2024. Studies on EMA/CO chemoresistance in gestational trophoblastic neoplasia (GTN) were included, and alternative regimens and surgical interventions were also considered. Exclusion applied to non-human studies and those unrelated to EMA/CO chemoresistance. Data extraction and quality assessment followed PRISMA, Cochrane ROB-2, and the Newcastle-Ottawa Scale. A meta-analysis was performed using a random-effects model, with heterogeneity (I²) and publication bias assessed. The study was registered with PROSPERO (CRD42024574582).</p> Results <p>Eight studies met the inclusion criteria, encompassing patients predominantly with advanced-stage (FIGO III-IV) and high-risk GTN. EMA/EP and EP/EMA were the most frequently evaluated salvage regimens, with a pooled complete remission rate of 78.7% (95% CI: 67.4–88.1%) across 84 patients. No significant heterogeneity (I² = 27.05%) or publication bias was detected. Alternative regimens, including BEP, FAEV, and TP/TE, demonstrated favourable remission rates in small cohorts but lacked generalizability. Neutropenia (68%), thrombocytopenia (41%), and anaemia (30%) were the most commonly reported toxicities with EP/EMA. Safety data for other regimens were limited.</p> Conclusion <p>EMA/EP and EP/EMA remain the most effective and well-studied salvage regimens for EMA/CO-resistant GTN, demonstrating high remission rates with manageable toxicity. While alternative regimens such as BEP, FAEV, and TP/TE show encouraging results, their limited evidence base precludes definitive comparison. Further prospective studies are needed to establish optimal salvage strategies and refine toxicity management.</p>

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Strategies for managing EMA/CO resistant in gestational trophoblastic neoplasia a systematic review and meta analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月14日

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  • Febia Erfiandi,
  • Setyo Teguh Waluyo,
  • Candra Novi Ricardo Sibarani,
  • Gatot Nyarumenteng Adhipurnawan Winarno,
  • Aini Sofa Haniah,
  • Nicholas Adrianto

摘要

Objective

This systematic review and meta-analysis evaluate the efficacy and safety of salvage regimens in managing EMA/CO-resistant GTN, providing evidence to inform optimal treatment strategies.

Methods

A literature search was conducted in PubMed, ScienceDirect, Cochrane Library, Google Scholar, and Wiley Online Library until December 27, 2024. Studies on EMA/CO chemoresistance in gestational trophoblastic neoplasia (GTN) were included, and alternative regimens and surgical interventions were also considered. Exclusion applied to non-human studies and those unrelated to EMA/CO chemoresistance. Data extraction and quality assessment followed PRISMA, Cochrane ROB-2, and the Newcastle-Ottawa Scale. A meta-analysis was performed using a random-effects model, with heterogeneity (I²) and publication bias assessed. The study was registered with PROSPERO (CRD42024574582).

Results

Eight studies met the inclusion criteria, encompassing patients predominantly with advanced-stage (FIGO III-IV) and high-risk GTN. EMA/EP and EP/EMA were the most frequently evaluated salvage regimens, with a pooled complete remission rate of 78.7% (95% CI: 67.4–88.1%) across 84 patients. No significant heterogeneity (I² = 27.05%) or publication bias was detected. Alternative regimens, including BEP, FAEV, and TP/TE, demonstrated favourable remission rates in small cohorts but lacked generalizability. Neutropenia (68%), thrombocytopenia (41%), and anaemia (30%) were the most commonly reported toxicities with EP/EMA. Safety data for other regimens were limited.

Conclusion

EMA/EP and EP/EMA remain the most effective and well-studied salvage regimens for EMA/CO-resistant GTN, demonstrating high remission rates with manageable toxicity. While alternative regimens such as BEP, FAEV, and TP/TE show encouraging results, their limited evidence base precludes definitive comparison. Further prospective studies are needed to establish optimal salvage strategies and refine toxicity management.