Pulse methotrexate versus pulse actinomycin D in the treatment of low-risk gestational trophoblastic neoplasia

Int J Gynaecol Obstet. 2008 Oct;103(1):33-7. doi: 10.1016/j.ijgo.2008.05.013. Epub 2008 Jul 16.


Objective: To compare the efficacy of methotrexate and actinomycin D as single agents in first-line chemotherapy for women with low-risk gestational trophoblastic neoplasia (LR-GTN).

Methods: A total of 131 women with LR-GTN were randomized to receive a weekly pulsed dose of 30 mg/m(2) of methotrexate intramuscularly (n=81) or a pulsed intravenous bolus of 1.25 mg/m(2) of actinomycin D every 2 weeks (n=50). An additional cycle was administered as consolidation treatment following normalization of the serum level of beta-human chorionic gonadotropin (<5 IU/L).

Results: Complete remission was achieved in 48.14% of patients in the methotrexate group and 90.00% in the actinomycin D group (P<0.001). The mean number of treatment cycles needed to achieve response was lower in the actinomycin D group (4.8 vs 6.8). The risk of treatment failure was 26.4 greater with methotrexate than with actinomycin D (95% confidence interval, 5.7-22.6; P<0.001).

Conclusion: Actinomycin D may be a better option than methotrexate as a first-line chemotherapy agent for patients with LR-GTN.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Antibiotics, Antineoplastic / administration & dosage
  • Antibiotics, Antineoplastic / adverse effects
  • Antibiotics, Antineoplastic / therapeutic use*
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects
  • Antimetabolites, Antineoplastic / therapeutic use*
  • Chorionic Gonadotropin, beta Subunit, Human / blood
  • Dactinomycin / administration & dosage
  • Dactinomycin / adverse effects
  • Dactinomycin / therapeutic use*
  • Female
  • Gestational Trophoblastic Disease / drug therapy*
  • Humans
  • Injections, Intramuscular
  • Injections, Intravenous
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects
  • Methotrexate / therapeutic use*
  • Pregnancy
  • Pulse Therapy, Drug
  • Remission Induction / methods
  • Risk
  • Treatment Failure
  • Young Adult


  • Antibiotics, Antineoplastic
  • Antimetabolites, Antineoplastic
  • Chorionic Gonadotropin, beta Subunit, Human
  • Dactinomycin
  • Methotrexate