Treatment for low-risk gestational trophoblastic disease: Comparison of single-agent methotrexate, dactinomycin and combination regimens

• Published in: Gynecologic oncology 2008-01, Vol.108 (1), p.149-153
• Main Authors: Abrão, Renato Antonio, de Andrade, Jurandyr Moreira, Tiezzi, Daniel Guimarães, Marana, Heitor Ricardo Cosiski, dos Reis, Francisco José Candido, Clagnan, Willian Simões
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Dactinomycin - administration & dosage; Dactinomycin - adverse effects; Dactinomycin - therapeutic use; Female; Gestational trophoblastic disease; Gestational Trophoblastic Disease - drug therapy; Gestational Trophoblastic Disease - pathology; Hematology, Oncology and Palliative Medicine; Human chorionic gonadotrophin; Humans; Methotrexate - administration & dosage; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Pregnancy; Retrospective Studies; Risk Factors
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2007.09.006

Abstract Objectives To compare the efficacy of three different standard chemotherapy regimens for low-risk gestational trophoblastic disease according to the FIGO staging system in a single-institute setting. Methods From 1980 until 2002, we retrospectively reviewed 108 cases with low-risk persistent gestational trophoblastic disease who were treated with first-line chemotherapy. Patients were divided in three groups according to chemotherapy regimen: patients treated with methotrexate (MTX group; n = 42), patients treated with dactinomycin (ACT group; n = 42) and patients treated with methotrexate and dactinomycin in combination (MACT group; n = 24). We compared the number of chemotherapy courses for achieving remission, the duration of treatment, the adverse side effects, the efficacy of the treatment and the need for performing a hysterectomy among the groups Results The complete remission rates were 69%, 61.4% and 79.1% for methotrexate (MTX), dactinomycin (ACT) and the combination regimen (MACT) treated groups, respectively ( p = 0.7). The duration of the treatment and the number of chemotherapy courses were similar among the groups ( p = 0.2 and p = 0.4, respectively). Adverse side effects rate was reported to be 62.5% in the MACT group, 28.6% in the MTX group and 19.1% in the ACT group ( p = 0.0003). Second-line chemotherapy was indicated for 30 patients. Hysterectomy was performed in 21 patients overall, and there was no difference among the groups ( p = 0.6). Conclusion Our analysis indicates that single-agent chemotherapy regimens are as effective as combination chemotherapy for low-risk gestational trophoblastic disease. Dactinomycin is a less toxic drug and might offer the best cost-effective treatment option. Methotrexate must be considered as the regimen of choice for low resource areas because of the feasibility of its administration.