Comparison of Chemotherapies with Methotrexate, VP-16 and Actinomycin-D in Low-Risk Gestational Trophoblastic Disease

Abstract

Objective: To compare the efficiency and toxicity of four chemotherapeutic regimens in low-risk gestational trophoblastic disease. Methods: Since 1974, 247 patients with low-risk gestational trophoblastic disease have been treated with 5-day intramuscular methotrexate (MTX) (conventional MTX), 5-day intravenous drip infusion of VP-16, 5-day intravenous actinomycin-D (Act-D) or 8-day alternating intramuscular MTX-folic acid (MTX-CF) at Chiba University School of Medicine. We compared the primary remission rate, the response of human chorionic gonadotropin and the prevalence of drug toxicities in these 4 regimens. Results: The primary remission rate was 73.6% in the conventional MTX regimen, 90.1% in VP-16, 84.0% in Act-D, and 60.0% in MTX-CF. The primary remission rate was significantly higher in the VP-16 and Act-D regimens than in the conventional MTX and MTX-CF regimens. The response rate was significantly higher in the VP-16 regimen than in the other 3 regimens. The drug toxicity with VP-16 and Act-D was less than that with conventional MTX and MTX-CF regimens. Conclusions: The VP-16 regimen was highly effective and less toxic for gestational trophoblastic disease compared with other chemotherapeutic regimens.

Comparison of methotrexate, actinomycin D, and etoposide for treating low‐risk gestational trophoblastic neoplasia

“…The primary remission rate of 80.0% obtained in the present study is similar to that of 78.9% obtained by Matsui et al [18], who compared the efficiency and toxicity of MTX-CF, conventional intramuscular methotrexate, actinomycin D, and etoposide in the treatment of low-risk GTD. The toxicity of etoposide was lower than that associated with methotrexate and MTX-CF; the authors concluded that etoposide was more effective and less toxic than the other regimens [18].…”

“…The toxicity of etoposide was lower than that associated with methotrexate and MTX-CF; the authors concluded that etoposide was more effective and less toxic than the other regimens [18].…”

Primary Ovary Choriocarcinoma: Individual DNA Polymorphic Analysis as a Strategy to Confirm Diagnosis and Treatment

“…For example, in cases involving stage 1 disease, total hysterectomy is the treatment of choice. However, for patients of childbearing age, this treatment can be replaced with chemotherapy with methotrexate and leucovorin or dactinomycin 21 , 22 . Both approaches should be maintained for at least three cycles following the normalization of β-HCG serum levels.…”

Criteria for Initiating Chemotherapy in Patients after Evacuation of Hydatidiform Mole

“…During this study period, we administered various regimens of chemotherapy to patients with low-risk GTT [13], and therefore we could not compare the numbers of chemotherapy courses. The incidence of metastases in patients who were started on chemotherapy based on our criteria of abnormal hCG regression was 39.4% (37/94), and lung metastasis was diagnosed based on CT findings in all cases.…”