title: Poor prognosis metastatic gestational trophoblastic disease: experience with moderate dose methotrexate plus folinic acid rescue as initial therapy.
abstract: From 1971 to 1981, twenty patients with poor-prognosis metastatic gestational trophoblastic neoplasia (GTN) were treated with moderate-dose methotrexate (1 g) and folinic-acid rescue (MD-MTX-FAR) as initial therapy. Seven (35%) were cured with MD-MTX-FAR, and salvage chemotherapy was successful in an additional seven, for a total cure rate of 70%. The ultimate outcome is similar to that reported for MAC triple therapy during this era. Hematologic and mucosal toxicity were negligible and no serious complications were encountered. We now use combination chemotherapy in patients with poor-prognosis GTN as first-line treatment. However, these results suggest that there may be advantages to the incorporation of MD-MTX-FAR in combination regimens in place of low-dose methotrexate, because of reduced toxicity and potential benefits for the prophylaxis and treatment of cerebral metastases.
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D002699:Chlorambucil / Q000008:administration & dosage; D006063:Chorionic Gonadotropin / Q000032:analysis; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007044:Hysterectomy; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D008727:Methotrexate / Q000008:administration & dosage; D011247:Pregnancy; D011379:Prognosis; D013997:Time Factors; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000401:mortality; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D006063:Chorionic Gonadotropin; D002699:Chlorambucil; D003609:Dactinomycin; D014747:Vinblastine; D002955:Leucovorin; D008727:Methotrexate