Evaluating methotrexate treatment in patients with low-risk postmolar gestational trophoblastic neoplasia

Gynecol Oncol. 2009 Feb;112(2):353-7. doi: 10.1016/j.ygyno.2008.11.003. Epub 2008 Dec 6.


Objective: To identify clinical factors associated with requiring more than a single course of Methotrexate (MTX) to achieve remission among women with low-risk postmolar gestational trophoblastic neoplasia (GTN).

Methods: We studied 150 women with persistent GTN after diagnosis of complete (n=110) or partial mole (n=40) to identify possible predictors of requiring additional treatment after a single treatment of methotrexate (MTX). All women had low-risk disease using FIGO and WHO scoring systems.

Results: Seventy women (47%) required additional courses of chemotherapy, of whom 45 (64%) received chemotherapy other than MTX. Multivariate analysis revealed that complete mole histology, presence of metastasis, single day MTX infusion and any increase in serum beta human chorionic gonadotropin (beta-hCG) level 1 week after MTX therapy were independent predictors of requiring additional MTX or alternative chemotherapy. Dilatation and curettage (D+C) within 1 week after the diagnosis of persistence did not affect future chemotherapy requirements (p>0.64). Following complete mole, beta-hCG levels >2000 mIU/mL at 1 week post MTX were associated with a 89% risk of additional cycles chemotherapy including MTX and a 65% risk of alternative chemotherapy.

Conclusions: Metastatic disease, MTX infusion protocol and complete mole histology were independently associated with the need for additional chemotherapy after an initial course of MTX for women with low risk GTN. D+C at persistence did not alter the chemotherapy requirement. Elevated beta-hCG level at 1 week after the initial course of MTX was also an independent factor predicting the need for additional courses of MTX or alternative chemotherapy.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Antimetabolites, Antineoplastic / therapeutic use*
  • Chorionic Gonadotropin, beta Subunit, Human / blood
  • Female
  • Gestational Trophoblastic Disease / blood
  • Gestational Trophoblastic Disease / drug therapy*
  • Humans
  • Hydatidiform Mole / pathology
  • Methotrexate / therapeutic use*
  • Neoplasm Staging
  • Predictive Value of Tests
  • Pregnancy
  • Risk Factors


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