| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 3945018 | Gynecologic Oncology | 2012 | 4 Pages |
ObjectiveTo determine factors associated with resistance to methotrexate treatment of low-risk gestational trophoblastic neoplasia (GTN).MethodsWe reviewed the records of 358 patients with low-risk GTN (FIGO stage I and stages II–III, score < 7) treated initially with methotrexate 0.4 mg/kg (max 25 mg) IV push daily × 5 days every 14 days between 1979 and 2009. Actinomycin D 0.5 mg IV push daily × 5 days every 14 days was used in 64 patients who developed resistance or toxicity to initial methotrexate chemotherapy, and combination drug regimens were used in 20 patients who failed single-agent chemotherapy. Adjuvant surgery was used in 34 selected patients. Clinical response and survival as well as factors affecting outcomes were analyzed retrospectively.ResultsThe complete response rate to initial methotrexate chemotherapy was 81% (290/358) and the complete response rate to actinomycin D as secondary therapy was 75% (48/64), for an overall complete response rate to sequential single-agent chemotherapy of 94% (338/358). The remaining 20 patients (6%) were all placed into permanent remission with the use of multiagent chemotherapy with or without surgery. Resistance to initial methotrexate chemotherapy was associated with increasing FIGO score (p < .0001), clinicopathologic diagnosis of choriocarcinoma (p = .028), higher pretreatment hCG (p = 0.001) and presence of metastatic, disease (p = .018).ConclusionsSequential single-agent chemotherapy with methotrexate (0.4 mg/kg–max 25 mg) followed by actinomycin D (0.5 mg) each given IV push for 5 consecutive days every other week for treatment of low-risk GTN resulted in only 6% of patients requiring multiagent chemotherapy and a 100% survival rate.
► The complete response rate to methotrexate chemotherapy for low-risk GTN was 81% ► The complete response rate to sequential single-agent chemotherapy for low-risk GTN was 94% ► Only 6% of low-risk GTN patients required multi-agent chemotherapy to achieve cure ► Stage, FIGO score, clinicopathology, and hCG level were associated with methotrexate resistance
