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Surgery-free treatment for ectopic pregnancies trialled

11 September, 2013

Monash Institute of Medical Research (MIMR) scientists have discovered a new treatment for women with an ectopic pregnancy.

In this dangerous condition, the embryo embeds in the fallopian tube rather than the uterus. Affecting one to two per cent of pregnancies, ectopic pregnancies can erode through maternal blood vessels, causing fatal internal bleeding. Ectopic pregnancies never result in successful, healthy pregnancies.

Crucially, the new treatment may reduce the need for surgery to remove the fallopian tube. This significantly improves the chances for women to have healthy pregnancies after recovering.

The research, published in the prestigious journal Obstetrics and Gynaecology, was led by MIMR's Associate Professor Terrance Johns, Melbourne University's Associate Professor Stephen Tong and Edinburgh University's Dr Andrew Horne.

In initial laboratory studies, Associate Professors Johns and Tong at MIMR found combining two drugs — methotrexate and gefitinib — showed exciting promise as a potential treatment for ectopic pregnancy. Methotrexate is a drug already used to treat ectopic pregnancies, but only works if the ectopic is small to begin with. Gefitinib blocks a cell survival signal and is used to treat lung cancer.

These laboratory experiments looked so promising the team took the concept into the clinic in a bid to improve patient care. In a world-first clinical trial conducted at Monash Health and Edinburgh (in collaboration with Dr Horne), 12 women suffering ectopic pregnancies were treated with these two drugs. They found ectopic pregnancies were cured 34 per cent faster and more effectively by using methotrexate and gefitinib drugs compared to giving methotrexate alone.

Dr Monika Skubisz, first author of the clinical trial research paper, said the major potential benefit of this treatment was the need for surgery to remove the fallopian tube is reduced in a significant number of cases. Possibly, the salvaged tube may still function and could spontaneously conceive future healthy pregnancies.

"One of the women in our trial, Elizabeth Cacencu, had already endured a previous ectopic pregnancy where one of her fallopian tubes was removed," Dr Skubisz said.

"This time the embryo had implanted in her second and only fallopian tube so it was vital for her to avoid surgery in order for her to naturally conceive again. We successfully treated her and she has since conceived and delivered a healthy baby which would not have been possible if she had to be forced to have her second tube removed."

Elizabeth's baby is now 22 months old and she says her ectopic pregnancy was cured by MIMR's treatment within one month of starting treatment.

"I am extremely grateful to have avoided surgery as Seth would not be here otherwise," Elizabeth said.

Associate Professor Stephen Tong, who came up with the concept while working at MIMR, says the team have already begun an expanded clinical trial to validate these results more broadly.

"If verified, a significantly faster time to cure with this new treatment may not only be clinically beneficial, but could make medical treatment of ectopic pregnancies the preferred option economically instead of surgery," Associate Professor Tong said.

MIMR and Monash Health, along with Prince Henry's Institute and Monash University, are all partners of the Monash Health Translation Precinct (MHTP) which strengthens translational research capabilities in Melbourne's South East leading expedited delivery of improved patient care and clinical practice in an integrated and systematic manner.

Associate Professors Tong and Johns were supported by funding from the MIMR Flagship grant and the National Health and Medical Research Council of Australia.

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