Weekly intravenous methotrexate with folinic acid for nonmetastatic gestational trophoblastic neoplasia.
OBJECTIVE
The objective of this study was to determine the complete response rate to weekly intravenous methotrexate at 100 mg/m(2) with folinic acid for patients with nonmetastatic gestational trophoblastic neoplasia.


METHODS
From 1988 to 1999, 22 women with nonmetastatic gestational trophoblastic neoplasia were treated with weekly intravenous methotrexate with folinic acid at the Hamilton Regional Cancer Centre. Complete response was defined as the attainment of a serum beta-hCG level <5 IU/L for 3 consecutive weeks. Toxicity was graded according to the National Cancer Institute of Canada-Clinical Trials Group criteria for chemotherapy toxicity.


RESULTS
There were 10 women who achieved complete response with weekly intravenous methotrexate alone (45.5%). Of the 12 who did not achieve complete response with methotrexate, 10 received actinomycin D and 2 received EMA as second-line chemotherapy. Patients successfully treated with methotrexate required a median of 6.5 cycles (including 2 cycles for consolidation) to achieve complete response. The only significant prognostic factor for failure with methotrexate was pretreatment beta-hCG (P = 0.01).


CONCLUSIONS
Only a select group of patients with low pretreatment beta-hCG titers would be expected to achieve complete response with this regimen. Large randomized studies are required to determine the optimal treatment for nonmetastatic gestational trophoblastic neoplasia.
Kwon
J S
JS
Division of Gynecologic Oncology, University of Toronto, Toronto, Canada.
Elit
L
L
Mazurka
J
J
Moens
F
F
Schmuck
M L
ML
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D012189:Retrospective Studies; D014328:Trophoblastic Neoplasms / Q000097:blood / Q000188:drug therapy*; D014594:Uterine Neoplasms / Q000097:blood / Q000188:drug therapy*
D018997:Chorionic Gonadotropin, beta Subunit, Human; D002955:Leucovorin; D008727:Methotrexate