EP410/#198 Stratified who risk score and chemotherapy response in gestational trophoblastic neoplasia

ObjectivesGrey zones exist in the management of gestational trophoblastic neoplasia(GTN). An analysis stratified into four risk groups is presented.MethodsRetrospective descriptive study of WHO risk groups;low risk(≤6);low(0–4) and intermediate(5–6), high risk(≥7);high(7–12) and ultra-high risk(≥13). Chemotherapy regimens, cycles for remission, side effects and cumulative delay were assessed.ResultsOf 22 cases of GTN, 13.6%(n=3) were low risk, 36.4%(n=8) intermediate risk, 40.9%(n=9) were high risk and 9.1(n=2) ultra-high risk. Presentations included vaginal bleeding 90.9%(n=18), lung metastasis 50.0%(n=11) and pulmonary artery thrombosis 13.6%(n=3). Low risk GTN received single agent methotrexate for mean 4.7±1.5 cycles. Women with WHO score 5(n=2) received methotrexate for mean 7.5±3.5 cycles. Women with score 6 (n=6);one received 8 cycles of methotrexate, one crossed over to EMACO and received 8 cycles. Three cases received EMACO for a mean of 8.7±4.5 cycles. Of high risk GTN(n=9), three received mean 6 cycles EMACO, another received 3 cycles induction with cisplatin/etoposide followed by 6 cycles EMACO, one required 9 cycles EMACO followed by pneumonectomy and 21 cycles of second-line chemotherapy but succumbed to disease. Two were lost to follow-up while two are on treatment. Ultra-high risk GTN(n=2), responded to 9 cycles of EMACO. Surgical interventions were needed in four. 15 achieved remission, two lost to follow up, two succumbed to disease and three on treatment. Grade1–2 toxicity were seen in majority. COVID 19 pandemic caused cumulative delay of 146 days in one with ultra-high risk GTN.ConclusionsResearch into newer and effective chemotherapy/targeted regimens for intermediate and high-risk GTN are needed.