First line chemotherapy in low risk gestational trophoblastic neoplasia

Dactinomycin is superior to methotrexate in achieving primary cure without significantly increasing toxicity in low risk gestational trophoplastic neoplasia.

A Cochrane review included 7 RCTs with a total of 667 subjects. All studies compared methotrexate with dactinomycin. Three studies compared weekly intramuscular (IM) methotrexate with bi-weekly pulsed intravenous (IV) actinomycin D (n=393), 1 study compared five-day IM methotrexate with bi-weekly pulsed IV actinomycin D (n=75), 1 study compared eight-day IM methotrexate-folinic acid (MTX-FA) with five-day IV actinomycin D (n=49), and 1 study compared eight-day IM MTX-FA with bi-weekly pulsed IV actinomycin D.Overall, dactinomycin was associated with significantly higher rates of primary cure than methotrexate (RR 0.65, 95% CI 0.57 to 0.75; 6 trials, n=577). Methotrexate was associated with significantly more treatment failure than dactinomycin (RR 3.55, 95% CI 1.81 to 6.95; 6 trials, n= 577). The combination of methotrexate-dactinomycin resulted in significantly increased toxicity without significantly improving primary cure rate.

Ədəbiyyat

1. Alazzam M, Tidy J, Hancock BW, Osborne R. First line chemotherapy in low risk gestational trophoblastic neoplasia. Cochrane Database Syst Rev 2009 Jan 21;(1):CD007102 [Review content assessed as up-to-date:18 January 2016].