Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/111491
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
Type: | Journal article |
Title: | Combination gefitinib and methotrexate treatment for non-tubal ectopic pregnancies: a case series |
Author: | Horne, A. Skubisz, M. Tong, S. Duncan, W. Neil, P. Wallace, E. Johns, T. |
Citation: | Human Reproduction, 2014; 29(7):1375-1379 |
Publisher: | Oxford University Press |
Issue Date: | 2014 |
ISSN: | 0268-1161 1460-2350 |
Statement of Responsibility: | A.W. Horne, M.M. Skubisz, S. Tong, W.C. Duncan, P. Neil, E.M.Wallace, and T.G. Johns |
Abstract: | Non-tubal ectopic pregnancies are a rare subgroup of ectopic pregnancies implanted at sites other than the Fallopian tube. Mortality from non-tubal ectopic pregnancies is higher compared with that for tubal ectopic pregnancies, and they are becoming more common, partly due to the rising incidence of Caesarean sections and use of assisted reproductive technologies. Non-tubal ectopic pregnancies can be especially difficult to treat. Surgical treatment is complex, and follow-up after medical treatment is usually protracted. There is therefore a need for more effective medical therapies to resolve non-tubal ectopic pregnancies and reduce operative intervention. We have recently reported successful use of combination gefitinib (an orally available epidermal growth factor receptor inhibitor) and methotrexate for treatment of tubal pregnancies. To our knowledge, this combination has not been used to treat non-tubal pregnancies. Here we report the use of combination gefitinib and methotrexate to treat eight women with stable, non-tubal ectopic pregnancies at two tertiary academic teaching hospitals (Edinburgh, UK and Melbourne, Australia); five interstitial and three Caesarean section scar ectopic pregnancies. Pretreatment serum hCG levels ranged from 2458 to 48 550 IU/l, and six women had pretreatment hCG levels >5000 IU/l. The women were co-administered 1-2 doses of i.m. methotrexate (50 mg/m² on Day 1, ± Day 4 or Day 7) with seven once daily doses of oral gefitinib (250 mg). The women were monitored until complete resolution of the ectopic pregnancy, defined as a serum hCG <15 IU/l. Time to resolution (days from first methotrexate dose until serum hCG <15 IU/l), safety and tolerability, complication rates and subsequent fertility outcomes were also recorded. All eight women were successfully treated with combination gefitinib and methotrexate. The most common side effects were transient acne/rash and diarrhoea, known side effects of gefitinib. All women promptly resumed menstruation and importantly, three women subsequently conceived spontaneously. Two have delivered a healthy infant at term and the third is currently in her second trimester of pregnancy. Hence, our case series supports a future clinical trial to determine the efficacy of combination gefitinib and methotrexate to treat non-tubal ectopic pregnancies. |
Keywords: | Ectopic pregnancy; epidermal growth factor receptor; gefitinib; methotrexate; non-tubal |
Description: | Advanced Access publication on May 7, 2014 |
Rights: | © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
DOI: | 10.1093/humrep/deu091 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/606611 http://purl.org/au-research/grants/nhmrc/1008276 http://purl.org/au-research/grants/nhmrc/1050765 |
Published version: | http://dx.doi.org/10.1093/humrep/deu091 |
Appears in Collections: | Aurora harvest 3 Obstetrics and Gynaecology publications |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
hdl_111491.pdf | Published version | 248.04 kB | Adobe PDF | View/Open |
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.