Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease.
Patients with nonmetastatic gestational trophoblastic disease were entered into this Gynecologic Oncology Group study to determine the efficacy, toxicity, and cost-effectiveness of weekly intramuscular (IM) methotrexate. Treatment was initiated with 30 mg/m2 of weekly IM methotrexate. If no major toxicity was encountered, the weekly dose was escalated 5 mg/m2 at three-week intervals until a maximum dose of 50 mg/m2 each week was achieved. Complete response was defined as three normal beta-hCG values measured on consecutive weeks. Fifty-one of 63 evaluable patients (81%) had a complete response to weekly IM methotrexate. Duration of therapy ranged from three to 19 weeks, with a median of seven. No major toxicity occurred. Thirteen patients experienced leukopenia at a median of 3300/microL, with a range of 2300-3900. Three patients had platelet nadirs of 66,000, 127,000, and 135,000/microL. Eleven patients with weekly IM methotrexate failure had a complete response after one to eight courses of dactinomycin administered 0.5 mg/m2 intravenously daily for five days; one refused therapy after three courses. Weekly IM methotrexate for nonmetastatic gestational trophoblastic disease is efficacious, minimally toxic, and cost-effective.
Homesley
H D
HD
Department of Obstetrics and Gynecology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.
Blessing
J A
JA
Rettenmaier
M
M
Capizzi
R L
RL
Major
F J
FJ
Twiggs
L B
LB
D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003609:Dactinomycin / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010446:Peptide Fragments / Q000097:blood; D010865:Pilot Projects; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D013997:Time Factors; D014328:Trophoblastic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D014594:Uterine Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000191:economics
D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments; D003609:Dactinomycin; D008727:Methotrexate