Weekly methotrexate (50 mg/m2) without dose escalation as a primary regimen for low-risk gestational trophoblastic neoplasia

ObjectivesThe aim of this study was to compare the efficacy and toxicity of an 8-day methotrexate–folinic acid regimen and a weekly methotrexate regimen (50 mg/m2 without dose escalation) for low-risk gestational trophoblastic neoplasia (GTN) according to the revised FIGO 2000 scoring system in a single institution.MethodsBetween January 1997 and June 2007, 107 patients with low-risk GTN were treated with an 8-day methotrexate–folinic acid regimen (MTX–FA group; n = 59) or a weekly methotrexate regimen (50 mg/m2 without dose escalation) (MTX group; n = 48). The primary remission rate, change of chemotherapy because of drug resistance or toxicity, and relapse rate were compared.ResultsAll 107 patients with low-risk GTN were cured. The primary remission rates were 69.5% and 70.8% for the MTX–FA and MTX groups, respectively (P > 0.99). The commonly reported toxic effects in the MTX–FA and MTX groups, respectively, were as follows: hepatotoxicity (31/59 and 9/48), neutropenia (7/59 and 4/48), stomatitis (3/59 and 2/48), alopecia (2/59 and 2/48), and thrombocytopenia (2/59 and 0/48). Drug toxicity necessitating changes in chemotherapy were reported to be 13.6% (8/59) in the MTX–FA group and 2.1% (1/48) in the MTX group (P < 0.05). The overall duration of treatment was 8.6 weeks in the MTX–FA group and 6.4 weeks in the MTX group (P < 0.001).ConclusionsThe weekly methotrexate regimen was as effective as the 8-day methotrexate–folinic acid regimen for low-risk GTN. The weekly methotrexate regimen was less toxic, better tolerated, and more convenient for patients compared to the 8-day methotrexate–folinic acid regimen.