Gestational trophoblastic neoplasia

Section editor
	Summer B. Dewdney, MD Chicago, IL

4 regimens on this page 6 variants on this page

Low-risk disease, all lines of therapy

Dactinomycin monotherapy

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Regimen

Study	Evidence	Comparator	Efficacy
Osborne et al. 2011 (GOG 0174)	Phase III (E)	Methotrexate	Seems to have superior CR rate

Chemotherapy

• Dactinomycin (Cosmegen) 1.25 mg/m² IV push once every 2 weeks

Treatment continued "until the βhCG assay had reached the institutional normal, or until either a rise or plateau in the βhCG level was observed"

References

1. GOG 0174: Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, Provencher D, Scott Miller D, Covens AL, Lage JM. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Mar 1;29(7):825-31. Epub 2011 Jan 24. link to original article link to PMC article contains verified protocol PubMed

Methotrexate monotherapy

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Regimen

Study	Evidence	Comparator	Efficacy
Osborne et al. 2011 (GOG 0174)	Phase III (C)	Dactinomycin	Seems to have inferior CR rate

Chemotherapy

• Methotrexate (MTX) 30 mg/m² IM once per week

Treatment continued "until the βhCG assay had reached the institutional normal, or until either a rise or plateau in the βhCG level was observed"

References

1. GOG 0174: Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, Provencher D, Scott Miller D, Covens AL, Lage JM. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Mar 1;29(7):825-31. Epub 2011 Jan 24. link to original article link to PMC article contains verified protocol PubMed