Effectiveness and Adverse Effects of Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine Regimen Among Gestational Trophoblastic Neoplasia Patients at Kenyatta National Hospital.

Abstract

Background: Etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMACO) regimen is used in the management of gestational trophoblastic neoplasia (GTN) to achieve cure. It has been shown to be highly effective. It is associated with a variety of adverse effects that are influenced by sociodemographic factors, co-morbidities, and concomitant therapy. Objective: The aim of this study was to determine effectiveness and adverse effects of EMACO regimen among GTN patients in Kenyatta National Hospital. Methodology: A longitudinal study was conducted on GTN patients treated with EMACO regimen in Kenyatta National Hospital (KNH), between March 2013 and April 2018. The sample size was determined using Cochrane formula for finite populations. Universal sampling was employed and sixty-eight participants were included in the study. Data on β-HCG levels, adverse effects, co-morbidities, concomitant therapy, diet and use of filgrastim prophylaxis was obtained from patient records. Data was entered into Microsoft Excel Spreadsheet and imported to STATA version 14 for analysis. The outcome of interest, beta HCG levels were used to construct the HCG regression nomograms, which enabled the determination of the effectiveness of EMACO regimen. The prevalence of adverse effects of EMACO regimen and use of filgrastim prophylaxis was determined. Bivariate analysis was done to show the outcome variable of interest across different arms of predictor variables. The outcome variable, adverse effects were regressed against potential predictor variables; age, nutritional status, co-morbidities, and concomitant therapy. Permission to conduct research was granted by KNH-UON Ethics and Research committee. Results: EMACO regimen was effective in 88% participants (59/68). Adverse effects were reversible and tolerable with myelosuppression being the most prevalent in (62,91.2%) participants. Other prevalent complications of EMACO regimen included extravasation (61,89.7%), nausea and vomiting (59,86.7%), alopecia (57,83.8%), diarrhea (47,69.1%), mucositis (43,63.2%) and loss of appetite in (38,55.9%). Increased occurrence of adverse effects was seen in the previous use of chemotherapy and metastatic disease. Filgrastim prophylaxis was administered to (29, 42.6%) participants who developed chemotherapy-induced neutropenia.

Conclusion: EMACO regimen achieves high remission rates for early GTN. A positive history of chemotherapy use and metastatic disease is associated with an increased tendency to develop adverse effects of EMACO regimen. Filgrastim prophylaxis maintained the treatment schedule among these patients. Recommendations: Adverse effects should be actively monitored especially in patients with metastatic disease and where chemotherapy has previously been used. Health workers administering chemotherapy should be well trained to minimize adverse effects