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/m² of methotrexate intramuscularly (n = 81) or a pulsed intravenous bolus of 1.25 mg/m² of actinomycin D every 2 weeks (n = 50). An additional cycle was administered as consolidation treatment following normalization of the serum level of β-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).

Conclusion

Actinomycin D may be a better option than methotrexate as a first-line chemotherapy agent for patients with LR-GTN.