Comparison of the efficacy of methotrexate and actinomycin D in the treatment of patients with stage I low risk gestational tro-phoblastic neoplasia (GTN)

Gestational trophoblastic neoplasia (GTN) refers to malignant lesions that arise from abnormal proliferation of placental trophoblast. Even in its metastatic forms GTN is curable with a cure rate of 90-100 %. Currently، methotrexate with or without folic acid، andactinomycin D is recommended for low risk GTN. The aim of this study is to compare the efficacy of methotrexate and actinomycin D as the first-line single chemotherapeutic agents for women with low-risk gestational trophoblastic neoplasia (LR-GTN). A total of 30 women with LR-GTN were randomized to receive a weekly pulsed dose of 40 mg/m (2) of methotrexate intramuscularly (n=15) or a pulsed intravenous bolus of 1. 25 mg/m (2) of actinomycin D every 2 weeks (n=15). An additional cycle was administered as consolidation treatment following normalization of the serum level of beta-human chorionic gonadotropin (˂10 IU/L). Complete remission was achieved in 53. 3% of patients in the methotrexate group and 86. 7% in the actinomycin D group (p˂0. 04). The mean number of treatment cycles needed to achieve response was lower in the actinomycin D group (4. 3 vs. 6. 5). The mean duration from beginning of treatment till achieving complete remission was 9. 6 weeks for the Act group and 13 weeks for the MTX group. Actinomycin D may be a better option than methotrexate as a first-line chemotherapy agent for patients with LR-GTN but larger multicenter randomized controlled trials should be conducted to establish the most appropriate regimen for these patients.