Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

Abstract

The aim of this study was to evaluate the efficacy and toxicity of low-dose methotrexate with folinic acid rescue in a large series of consecutively treated patients with low-risk persistent gestational trophoblastic disease. Between January 1987 and December 2000, 250 patients were treated with intramuscular methotrexate (50 mg on alternate days 1, 3, 5, 7) with folinic acid (7.5 mg orally on alternate days 2, 4, 6, 8) rescue. The overall complete response rate without recurrence was 72% for first-line treatment and 95% for those who required second-line chemotherapy. Eight women (3.2%) had recurrence following remission and two (0.8%) had new moles. Two women (0.8%) died of their disease giving an overall cure of 99%. Only 10 women (4%) experienced grade III/IV toxicity during the first course of treatment and 13 women (5.2%) subsequently. Toxicity included mucositis and stomatitis, pleuritic chest pain, thrombocytopenia, uterine bleeding, abdominal pain, liver function changes, rash and pericardial effusion. A total of 59 women (23.6%) required second-line chemotherapy; 48 women had methotrexate resistance, eight had methotrexate toxicity and an empirical decision to change therapy was made in three. In all, 11 women (4.4%) had a hysterectomy before, during or after treatment; 141 women (56.4%) became pregnant following treatment: in 128 (90.7%), the outcome was successful. Methotrexate with folinic acid rescue is an effective treatment for low-risk persistent trophoblastic disease. It has minimal severe toxicity, excellent cure rates and does not appear to affect fertility.

Gestational Trophoblastic Neoplasia: Experience from a Tertiary Care Center of India

“…This protocol could be a good option in low-risk patients especially in developing countries. Our treatment outcomes are comparable with national and international data in low-risk disease [9][10][11][12].…”

“…The total number of chemotherapy cycles received on average was 7.08 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In high-risk patients, average number of cycles received was 7.6 (4-11), while in lowrisk patients, it was 6.13 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…The average number of chemotherapy cycles received for normalization of serum b-hCG levels was 4.82 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12).In high-risk group, patients received on average 5.1 cycles (3-8), while in low-risk group, patients received on average 4.46 cycles (2-12) for normalization of serum b-hCG levels.…”

“…In high-risk patients, average number of cycles received was 7.6 (4-11), while in lowrisk patients, it was 6.13 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…In another study from India, 92.9 % of post-molar GTN attained complete remission with MTX [7]. Other studies from developed countries have reported lower rates of remission (72 %) with MTX and higher requirement of second-line salvage regimens [8]. Although it is difficult to draw definitive conclusions, it is possible that there may not be proper risk stratification in developing countries, and patients with risk scores of five and six may be relapsing on single-agent chemotherapy.…”