title: Comparison of methotrexate, actinomycin D, and etoposide for treating low-risk gestational trophoblastic neoplasia.
abstract: OBJECTIVE
  To compare the efficacy and toxicity of 3 single agent chemotherapeutic regimens in low-risk gestational trophoblastic neoplasia (LRGTN).
  
  
  METHODS
  A prospective study was conducted at a referral center in Rio de Janeiro, Brazil. Patients presenting with metastatic or non-metastatic LRGTN (risk score ≤ 6) in non-probabilistic sampling were assigned to 1 of 3 treatments: methotrexate with folinic acid rescue (MTX-CF; n=20); actinomycin D (n=20); and etoposide (n=20). Women with less than 1 year of disease-free follow-up after the first normal human chorionic gonadotropin (hCG) value were excluded. Outcome measures included primary remission rate; resistance to primary and sequential chemotherapy; period between treatment initiation and remission (hCG response); and prevalence of toxic effects.
  
  
  RESULTS
  Primary remission was achieved by 48 patients (80.0%). The remission rate with etoposide was 100.0%, while the rates with actinomycin D and MTX-CF were 90.0% and 50.0%, respectively. Efficacy of etoposide was significantly greater than the other 2 agents (P<0.001). Alopecia was the most frequent adverse effect caused by etoposide. Common to all protocols were stomatitis, nausea, and vomiting. Mean time intervals between beginning treatment and remission were similar and all 60 participants survived.
  
  
  CONCLUSIONS
  Etoposide was the most effective regimen for treating metastatic and non-metastatic LRGTN.
authors.affiliation: Brazilian Society of Gestational Trophoblastic Neoplasia, Rio de Janeiro, Brazil.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Baptista
authors.forename: Paulo
authors.initials: P
authors.lastname: Belfort
mesh_terms: D000328:Adult; D000505:Alopecia / Q000139:chemically induced; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000097:blood; D003609:Dactinomycin / Q000009:adverse effects / Q000627:therapeutic use*; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D009325:Nausea / Q000139:chemically induced; D011247:Pregnancy; D011446:Prospective Studies; D012074:Remission Induction; D013280:Stomatitis / Q000139:chemically induced; D014803:Vitamin B Complex / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D006063:Chorionic Gonadotropin; D014803:Vitamin B Complex; D003609:Dactinomycin; D005047:Etoposide; D002955:Leucovorin; D008727:Methotrexate