5-day methotrexate for women with metastatic gestational trophoblastic disease.
The objective of this study was to analyze the toxicity and the efficacy of single-agent 5-day methotrexate for women with metastatic gestational trophoblastic disease. The study is a retrospective analysis of 52 patients who received repetitive 5-day cycles of intramuscular methotrexate as primary therapy for metastatic trophoblastic disease between 1975 and 1990. The majority of patients were low-risk by both clinical and World Health Organization prognostic index score criteria. Sixty percent achieved primary remission with a median of 3 cycles of single-agent methotrexate. Therapy was changed because of toxicity and drug-resistance by hCG criteria in 11 (21%) and 10 (19%) patients, respectively. Pretherapy hCG > 10,000 mIU/ml was associated with the development of drug-resistance. Remission was achieved in all patients, with only 2 (4%) requiring multiagent therapy. The use of repetitive 5-day cycles of methotrexate is efficacious therapy of low-risk metastatic trophoblastic disease. Future studies are needed to define a cost-effective and minimally toxic therapy that retains a high primary remission rate in these patients.
Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina 27710.
J T
JT
Soper
D L
DL
Clarke-Pearson
A
A
Berchuck
G
G
Rodriguez
C B
CB
Hammond
D000704:Analysis of Variance; D006063:Chorionic Gonadotropin / Q000097:blood; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000556:secondary; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology; D014625:Vaginal Neoplasms / Q000188:drug therapy / Q000556:secondary
D006063:Chorionic Gonadotropin; D008727:Methotrexate