Pulse methotrexate versus pulse actinomycin D in the treatment of low-risk gestational trophoblastic neoplasia.
OBJECTIVE
To compare the efficacy of methotrexate and actinomycin D as single agents in first-line chemotherapy for women with low-risk gestational trophoblastic neoplasia (LR-GTN).


METHODS
A total of 131 women with LR-GTN were randomized to receive a weekly pulsed dose of 30 mg/m(2) of methotrexate intramuscularly (n=81) or a pulsed intravenous bolus of 1.25 mg/m(2) of actinomycin D every 2 weeks (n=50). An additional cycle was administered as consolidation treatment following normalization of the serum level of beta-human chorionic gonadotropin (<5 IU/L).


RESULTS
Complete remission was achieved in 48.14% of patients in the methotrexate group and 90.00% in the actinomycin D group (P<0.001). The mean number of treatment cycles needed to achieve response was lower in the actinomycin D group (4.8 vs 6.8). The risk of treatment failure was 26.4 greater with methotrexate than with actinomycin D (95% confidence interval, 5.7-22.6; P<0.001).


CONCLUSIONS
Actinomycin D may be a better option than methotrexate as a first-line chemotherapy agent for patients with LR-GTN.
Yarandi
Fariba
F
Department of Gynecological Oncology, Medicine School, Medical Sciences/University of Tehran, Tehran, Iran. Fariba_Yarandi@Yahoo.com
Eftekhar
Zahra
Z
Shojaei
Hadi
H
Kanani
Soheyla
S
Sharifi
Ali
A
Hanjani
Parviz
P
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy*; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D020551:Pulse Therapy, Drug; D012074:Remission Induction / Q000379:methods; D012306:Risk; D017211:Treatment Failure; D055815:Young Adult
D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D018997:Chorionic Gonadotropin, beta Subunit, Human; D003609:Dactinomycin; D008727:Methotrexate