5-DAY METHOTREXATE FOR WOMEN WITH METASTATIC GESTATIONAL TROPHOBLASTIC DISEASE

The objective of this study was to analyze the toxicity and the effica cy of single-agent 5-day methotrexate for women with metastatic gestat ional trophoblastic disease. The study is a retrospective analysis of 52 patients who received repetitive 5-day cycles of intramuscular meth otrexate as primary therapy for metastatic trophoblastic disease betwe en 1975 and 1990. The majority of patients were low-risk by both clini cal and World Health Organization prognostic index score criteria. Six ty percent achieved primary remission with a median of 3 cycles of sin gle-agent methotrexate. Therapy was changed because of toxicity and dr ug-resistance by hCG criteria in 11 (21%) and 10 (19%) patients, respe ctively. Pretherapy hCG >10,000 mIU/ml was associated with the develop ment of drug-resistance. Remission was achieved in all patients, with only 2 (4%) requiring multiagent therapy. The use of repetitive 5-day cycles of methotrexate is efficacious therapy of low-risk metastatic t rophoblastic disease. Future studies are needed to define a cost-effec tive and minimally toxic therapy that retains a high primary remission rate in these patients. (C) 1994 Academic Press, Inc.