Gestational trophoblastic neoplasia

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Summer B. Dewdney, MD
Chicago, IL
2 regimens on this page
2 variants on this page


Guidelines

ESMO

NCCN

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

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
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

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