{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T22:24:43Z","timestamp":1794003883872,"version":"4.8.0"},"reference-count":25,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2024\/02607-4"],"award-info":[{"award-number":["2024\/02607-4"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2018\/10698-9"],"award-info":[{"award-number":["2018\/10698-9"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["CAPES-PRINT 88887. 936593\/2024-0"],"award-info":[{"award-number":["CAPES-PRINT 88887. 936593\/2024-0"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["CAPES-PROEX 88887.824444\/2023-00"],"award-info":[{"award-number":["CAPES-PROEX 88887.824444\/2023-00"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["CAPES-PRINT - 88887.936692\/2024-00"],"award-info":[{"award-number":["CAPES-PRINT - 88887.936692\/2024-00"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["international-journal-of-gynecological-cancer.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Gynecological Cancer"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1016\/j.ijgc.2026.104904","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:23:53Z","timestamp":1785453833000},"page":"104904","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Actinomycin D versus etoposide, methotrexate, actinomycin D\/cyclophosphamide, and vincristine as second-line treatment in low-risk gestational trophoblastic neoplasia with primary methotrexate resistance"],"prefix":"10.1016","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8145-2962","authenticated-orcid":false,"given":"Mariza","family":"Branco-Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firas","family":"Charfare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5373-5762","authenticated-orcid":false,"given":"Ehsan","family":"Ghorani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveed","family":"Sarwar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7162-4035","authenticated-orcid":false,"given":"Baljeet","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reece","family":"Caldwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea","family":"Ghataore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5875-7335","authenticated-orcid":false,"given":"Izildinha","family":"Maesta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4078-2599","authenticated-orcid":false,"given":"Michael J.","family":"Seckl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"18","key":"10.1016\/j.ijgc.2026.104904_bib1","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1200\/JCO-24-02326","volume":"43","author":"Lok","year":"2025","journal-title":"J Clin Oncol"},{"issue":"suppl 1","key":"10.1016\/j.ijgc.2026.104904_bib2","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1002\/ijgo.70275","article-title":"Diagnosis and management of gestational trophoblastic disease: 2025 update","volume":"171","author":"Ngan","year":"2025","journal-title":"Int J Gynaecol Obstet"},{"issue":"3","key":"10.1016\/j.ijgc.2026.104904_bib3","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/S0020-7292(02)00063-2","article-title":"FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee","volume":"77","year":"2002","journal-title":"Int J Gynaecol Obstet"},{"issue":"1","key":"10.1016\/j.ijgc.2026.104904_bib4","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1186\/s12885-021-08849-7","article-title":"Direct comparisons of efficacy and safety between actinomycin-D and methotrexate in women with low-risk gestational trophoblastic neoplasia: a meta-analysis of randomized and high-quality non-randomized studies","volume":"21","author":"Hao","year":"2021","journal-title":"BMC Cancer"},{"issue":"10","key":"10.1016\/j.ijgc.2026.104904_bib5","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.annonc.2025.06.006","article-title":"Efficacy and safety of biweekly single-dose actinomycin D versus multiday methotrexate in low-risk gestational trophoblastic neoplasia: a prospective multicenter randomized trial","volume":"36","author":"Jiang","year":"2025","journal-title":"Ann Oncol"},{"issue":"6","key":"10.1016\/j.ijgc.2026.104904_bib6","article-title":"First-line chemotherapy in low-risk gestational trophoblastic neoplasia","volume":"6","author":"Lawrie","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"7","key":"10.1016\/j.ijgc.2026.104904_bib7","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1200\/JCO.2010.30.4386","article-title":"Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a gynecologic oncology group study","volume":"29","author":"Osborne","year":"2011","journal-title":"J Clin Oncol"},{"issue":"9","key":"10.1016\/j.ijgc.2026.104904_bib8","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1002\/1097-0142(19871101)60:9<2173::AID-CNCR2820600910>3.0.CO;2-3","article-title":"Single-dose actinomycin-D treatment for nonmetastatic gestational trophoblastic disease. A prospective phase II trial of the gynecologic oncology group","volume":"60","author":"Petrilli","year":"1987","journal-title":"Cancer"},{"issue":"10","key":"10.1016\/j.ijgc.2026.104904_bib9","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/j.annonc.2025.07.018","article-title":"Current and future treatments for low-risk gestational trophoblastic neoplasia","volume":"36","author":"Seckl","year":"2025","journal-title":"Ann Oncol"},{"issue":"9742","key":"10.1016\/j.ijgc.2026.104904_bib10","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/S0140-6736(10)60280-2","article-title":"Gestational trophoblastic disease","volume":"376","author":"Seckl","year":"2010","journal-title":"Lancet"},{"issue":"1","key":"10.1016\/j.ijgc.2026.104904_bib11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/GCO.0000000000000674","article-title":"Treatment of gestational trophoblastic disease in the 2020s","volume":"33","author":"Clark","year":"2021","journal-title":"Curr Opin Obstet Gynecol"},{"issue":"6","key":"10.1016\/j.ijgc.2026.104904_bib12","doi-asserted-by":"crossref","first-page":"643.e1","DOI":"10.1016\/j.ajog.2009.03.011","article-title":"Methotrexate for 2000 FIGO low-risk gestational trophoblastic neoplasia patients: efficacy and toxicity","volume":"200","author":"Chalouhi","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ijgc.2026.104904_bib13","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ejca.2020.02.011","article-title":"Clinical Working Party of the EOTTD. Practical clinical guidelines of the EOTTD for treatment and referral of gestational trophoblastic disease","volume":"130","author":"Lok","year":"2020","journal-title":"Eur J Cancer"},{"issue":"11","key":"10.1016\/j.ijgc.2026.104904_bib14","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1038\/bjc.2012.462","article-title":"Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000\u20132009","volume":"107","author":"Sita-Lumsden","year":"2012","journal-title":"Br J Cancer"},{"key":"10.1016\/j.ijgc.2026.104904_bib15","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.bpobgyn.2021.01.006","article-title":"Treatment of low-risk gestational trophoblastic neoplasia","volume":"74","author":"Winter","year":"2021","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"5","key":"10.1016\/j.ijgc.2026.104904_bib16","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1038\/sj.bjc.6603608","article-title":"A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia","volume":"96","author":"Powles","year":"2007","journal-title":"Br J Cancer"},{"issue":"3","key":"10.1016\/j.ijgc.2026.104904_bib17","doi-asserted-by":"crossref","DOI":"10.1016\/j.esmoop.2021.100110","article-title":"Increasing the human chorionic gonadotrophin cut-off to \u22641000 IU\/l for starting actinomycin D in post-molar gestational trophoblastic neoplasia developing resistance to methotrexate spares more women multi-agent chemotherapy","volume":"6","author":"Cort\u00e9s-Charry","year":"2021","journal-title":"ESMO Open"},{"issue":"7","key":"10.1016\/j.ijgc.2026.104904_bib18","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1200\/JCO.1997.15.7.2636","article-title":"EMA\/CO for high-risk gestational trophoblastic tumors: results from a cohort of 272 patients","volume":"15","author":"Bower","year":"1997","journal-title":"J Clin Oncol"},{"issue":"7-8","key":"10.1016\/j.ijgc.2026.104904_bib19","first-page":"279","article-title":"Low-risk gestational trophoblastic neoplasia and methotrexate resistance: predictors of response to treatment with actinomycin D and need for combination chemotherapy","volume":"55","author":"Growdon","year":"2010","journal-title":"J Reprod Med"},{"issue":"7-8","key":"10.1016\/j.ijgc.2026.104904_bib20","first-page":"283","article-title":"Actinomycin D for methotrexate-failed low-risk gestational trophoblastic neoplasia","volume":"57","author":"Lurain","year":"2012","journal-title":"J Reprod Med"},{"issue":"7","key":"10.1016\/j.ijgc.2026.104904_bib21","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1200\/JCO.2002.07.166","article-title":"Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000","volume":"20","author":"Mcneish","year":"2002","journal-title":"J Clin Oncol"},{"issue":"5","key":"10.1016\/j.ijgc.2026.104904_bib22","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1097\/IGC.0000000000001248","article-title":"Efficacy and safety of second-line 5-day dactinomycin in case of methotrexate failure for gestational trophoblastic neoplasia","volume":"28","author":"Prouvot","year":"2018","journal-title":"Int J Gynecol Cancer"},{"issue":"4","key":"10.1016\/j.ijgc.2026.104904_bib23","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.3802\/jgo.2020.31.e36","article-title":"The 16-year experience in treating low-risk gestational trophoblastic neoplasia patients with failed primary methotrexate chemotherapy","volume":"31","author":"Wu","year":"2020","journal-title":"J Gynecol Oncol"},{"issue":"2","key":"10.1016\/j.ijgc.2026.104904_bib24","first-page":"141","article-title":"Drug resistance and combating drug resistance in cancer","volume":"2","author":"Wang","year":"2019","journal-title":"Cancer Drug Resist"},{"issue":"5","key":"10.1016\/j.ijgc.2026.104904_bib25","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1200\/JCO.2014.57.5332","article-title":"Effects of single-agent and combination chemotherapy for gestational trophoblastic tumors on risks of second malignancy and early menopause","volume":"33","author":"Savage","year":"2015","journal-title":"J Clin Oncol"}],"container-title":["International Journal of Gynecological Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1048891X26004354?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1048891X26004354?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T21:33:00Z","timestamp":1794000780000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1048891X26004354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":25,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["S1048891X26004354"],"URL":"https:\/\/doi.org\/10.1016\/j.ijgc.2026.104904","relation":{},"ISSN":["1048-891X"],"issn-type":[{"value":"1048-891X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Actinomycin D versus etoposide, methotrexate, actinomycin D\/cyclophosphamide, and vincristine as second-line treatment in low-risk gestational trophoblastic neoplasia with primary methotrexate resistance","name":"articletitle","label":"Article Title"},{"value":"International Journal of Gynecological Cancer","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ijgc.2026.104904","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 European Society of Gynaecological Oncology and the International Gynecologic Cancer Society. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"104904"}}