alexa Five-Day Intravascular Methotrexate Versus Biweekly Actinomycin-D in the Treatment of Low-Risk Gestational Trophoblastic Neoplasia: A Clinical Randomized Trial.


Journal of Kidney

Author(s): Yarandi F, Mousavi A, Abbaslu F, Aminimoghaddam S, Nekuie S,

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Abstract OBJECTIVES: Methotrexate (MTX) and Actinomycin-D (Act-D) are effective drugs used in the treatment of low-risk gestational trophoblastic neoplasia (LRGTNs). The aim of the present study was to compare intravenous (IV) MTX and IV Act-D in the treatment of LRGTNs. MATERIALS AND METHODS: Sixty-two patients with LRGTN were enrolled in a prospective randomized clinical trial between 2010 and 2013 in Moheb e Yas Hospital, Tehran University of Medical Sciences. Primary treatment regimens were IV MTX, 0.4 mg/kg daily for 5 days every 14 days (25 mg maximum daily dose), and IV Act-D, 1.25 mg/m (2 mg maximum dose) every 14 days. RESULTS: Thirty-two and 30 patients were enrolled to MTX and Act-D groups, respectively. Complete remission after receiving first-line chemotherapy was achieved in 79\% of all cases, 80\% in the Act-D group and 78.1\% in the MTX group.Twenty percent of the Act-D patients and 21.9\% of the MTX patients showed resistance to the first-line chemotherapy, of which 16.7\% and 15.6\% responded completely to the second-line monotherapy, respectively. Multiple drug therapy was needed in 3.3\% of the Act-D group and 6.3\% of the MTX group.We did not find any correlation between treatment response and beta-human chorionic gonadotropin level, uterine mass size, lung metastasis, antecedent pregnancy, and duration from diagnosis to treatment. Adverse effects were not statistically different between the 2 groups. CONCLUSIONS: Single-agent chemotherapy in the treatment of LRGTNs resulted in an overall complete remission rate of 79\%, 80\% in the Act-D group and 78.1\% in MTX group, with no statistically significant difference. Whereas this study represents an important step in comparing single-agent treatments, comparison of other regimens will be required to determine the optimal single-agent therapy. This article was published in Int J Gynecol Cancer and referenced in Journal of Kidney

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