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In the only large randomised comparison of the two standard single drugs for low-risk GTN, dactinomycin given once a fortnight cured more women than weekly methotrexate, though both were followed by successful rescue in almost everyone.
Gynecologic Oncology Group randomised phase 3 trial of 216 eligible women with low-risk gestational trophoblastic neoplasia (WHO score 0 to 6) assigned to weekly intramuscular methotrexate 30 mg/m2 or pulsed intravenous dactinomycin 1.25 mg/m2 every two weeks.
Complete response occurred in 70 percent with dactinomycin against 53 percent with methotrexate; women with a score of 5 to 6 or with choriocarcinoma did poorly with either drug. Nearly all women who failed were cured with subsequent therapy.
Pulsed dactinomycin is at least as good as weekly methotrexate for low-risk GTN, but many centres still prefer the multi-day methotrexate-folinic acid schedule, which was not tested here; overall cure approaches 100 percent whichever drug comes first.
Shares Dactinomycin (actinomycin D), Methotrexate, Journal of Clinical Oncology.
Shares Dactinomycin (actinomycin D), Methotrexate.
Shares Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), Journal of Clinical Oncology.
Shares Methotrexate, Journal of Clinical Oncology.
Shares Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), Dactinomycin (actinomycin D), Methotrexate.
Shares Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), Dactinomycin (actinomycin D), Methotrexate.
Shares Dactinomycin (actinomycin D), Methotrexate.
Shares Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), Dactinomycin (actinomycin D), Methotrexate.