Weekly intramuscular methotrexate in the treatment of low-risk gestational trophoblastic neoplasia.
OBJECTIVE
The objective of this study was to determine the efficacy of weekly intramuscular (IM) methotrexate without dose escalation as first-line chemotherapy for low-risk gestational trophoblastic neoplasia (LRGTN).


METHODS
Thirty-three women with post-molar LRGTN in the division of gynecology oncology at the Shiraz University of Medical Sciences were treated with weekly IM methotrexate at 30 mg/m(2) without dose escalation. The serum level of beta-hCG was detected every week. After the first negative beta-hCG level, one more cycle was administered as consolidation. Complete response (CR) was defined as the attainment of serum beta-hCG level of 5 IU/L or less measured on three consecutive weeks.


RESULTS
Twenty-one of 33 women (63.6%) achieved CR with weekly IM injection of 30 mg/m(2) methotrexate. Ten of 12 patients with weekly IM methotrexate failure had a CR after one to three courses of dactinomycin administered at 1.25 mg/m(2) intravenously every 2 weeks. Two patients needed multiple-agent chemotherapy for remission.


CONCLUSIONS
Weekly methotrexate without dose escalation may be an appropriate option for primary chemotherapy of patients with LRGTN.
Mohit
Mitra
M
Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran. mitramohita@gmail.com
Sarraf
Zahra
Z
Sheikhi
Gelavizh
G
Robati
Minoo
M
Vasheghani-Farahani
Amir
A
D000293:Adolescent; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D055815:Young Adult
D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate