Gestational trophoblastic neoplasia

Section editor
	Summer B. Dewdney, MD Rush University Chicago, IL

4 regimens on this page 6 variants on this page

Guidelines

ESMO

• 2013: Seckl et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

NCCN

• NCCN Guidelines - Gestational Trophoblastic Neoplasia

Low-risk disease, all lines of therapy

Dactinomycin monotherapy

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Regimen

Study	Evidence	Comparator	Comparative 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

Mercaptopurine & Methotrexate

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Regimen

Study	Evidence
Li et al. 1958	Pilot

Note: this is of historic interest.

Chemotherapy

• Mercaptopurine (6-MP)
• Methotrexate (MTX)

References

1. Li MC, Hertz R, Bergenstal DM. Therapy of choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists. N Engl J Med. 1958 Jul 10;259(2):66-74. link to original article PubMed

Methotrexate monotherapy

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Regimen

Study	Evidence	Comparator	Comparative Efficacy
Li et al. 1958	Pilot
Homesley et al. 1988	Phase II
Osborne et al. 2011 (GOG 0174)	Phase III (C)	Dactinomycin	Seems to have inferior CR rate

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.

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. Homesley HD, Blessing JA, Rettenmaier M, Capizzi RL, Major FJ, Twiggs LB. Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Obstet Gynecol. 1988 Sep;72(3 Pt 1):413-8. link to original article PubMed
2. 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