Efficacy of Oral Vitamin A in Reducing β-hCG Levels in Low-Risk Gestational Trophoblastic Neoplasia Patients.

Yudi Hidayat,Tono Djuwantono,Sylvia Rachmayati,Eppy Darmadi A,Akhmad Pramatirta,Dodi Suardi,Windy Kusumah

doi:10.31557/apjcp.2020.21.11.3325

Abstract

Objective:Low-risk gestational trophoblastic neoplasia (GTN) is generally treated with single agent chemotherapy and methotrexate (MTX) as a first-line therapy. Vitamin A helps to increase trophoblast cell regression, as well as to decrease β-hCG levels. Vitamin A also increases the effectiveness of MTX by inducing more malignant cell death than MTX alone. Therefore, the aim of the current study was to analyze the changes in β-hCG levels in low-risk GTN patients following vitamin A administration. Methods:This study was a randomized clinical trial, which examined initial serum vitamin A and β-hCG levels in GTN patients before and after three cycles of MTX therapy. Patients were given vitamin A supplementation of 6,000 IU (1.8 mg RAEs) per day, and the changes in serum β-hCG were observed after three cycles. Patients were grouped by β-hCG levels (decreased or stagnant). Results:A total of 32 low-risks GTN patients were divided into the intervention group (16 patients who received vitamin A supplementation) and the control group (16 patients who did not receive vitamin A supplementation). In the intervention group, the average initial β-hCG level was 170,949.3 ± 354,452.1 mIU/mL, and the average β-hCG post-cycle level was 1,611.9 ± 3,652.5 mIU/mL. In the control group, the average initial β-hCG level was 178,834.1 ± 2913844.6 mIU/mL, and the average β-hCG post-cycle level was 25,388.5 ± 58,437.7 mIU/mL. Conclusion:In patients with low-risk GTN who underwent MTX chemotherapy, the levels of β-hCG and the incidence of chemo resistance in the intervention group were lower than those in the control group. Older age may also influence the incidence of chemo resistance in GTN patients. Oral administration of 6,000 IU vitamin A could help to reduce β-hCG levels in low-risk GTN patients who receive MTX chemotherapy.

Highlights

Gestational trophoblast disease (GTD) comprises a group of diseases that develop after conception causes abnormal placental development characterized by abnormal trophoblastic cell proliferation
Low-risk Gestational trophoblast tumors (GTTs) are generally treated with single agent chemotherapy and methotrexate (MTX) as a first-line therapy, which tends to show a good response in patients
Vitamin A is a fat soluble vitamin which is absorbed through a carrier protein (Goncalves et al, 2015)

Summary

Introduction

Gestational trophoblast disease (GTD) comprises a group of diseases that develop after conception causes abnormal placental development characterized by abnormal trophoblastic cell proliferation. Vitamin A has an important role in the regulation of cell proliferation, differentiation, and apoptosis by increasing p53 activity, which causes arrest in the G1 phase and the Bcl-2 gene which encourages apoptosis (Ghasemian et al, 2018). These roles of vitamin A are considered to have a synergistic effect on the action of MTX in inhibiting cell proliferation in the S phase of the cell cycle (Skubisz and Tong, 2012; Ghasemian et al, 2018). Two other studies showed that vitamin A helps to decrease serum β-hCG levels in patients with low-risk GTTs who receive MTX therapy (Sutanto et al, 2012; Ghasemian et al, 2018). We sought to investigate the changes in β-hCG levels in patients with low-risk gestational trophoblastic neoplasia following vitamin A administration

Materials and Methods

Results

Discussion