Weekly intravenous methotrexate with folinic acid for nonmetastatic gestational trophoblastic neoplasia

Objective. The objective of this study was to determine the complete respon se rate to weekly intravenous methotrexate at 100 mg/m(2) with folinic. aci d for patients with nonmetastatic gestational trophoblastic neoplasia. Methods. From 1988 to 1999, 22 women with nonmetastatic gestational trophob lastic neoplasia were treated with weekly intravenous methotrexate with fol inic acid at the Hamilton Regional Cancer Centre. Complete response was def ined as the attainment of a serum beta -hCG level < 5 IU/L for 3 consecutiv e weeks. Toxicity was graded according to the National Cancer Institute of Canada-Clinical Trials Group criteria for chemotherapy toxicity. Results. There were 10 women who achieved complete response with weekly int ravenous methotrexate alone (45.5%). Of the 12 who did not achieve complete response with methotrexate, 10 received actinomycin D and 2 received EMA a s second-line chemotherapy. Patients successfully treated with methotrexate required a median of 6.5 cycles (including 2 cycles for consolidation) to achieve complete response. The only significant prognostic factor for failu re with methotrexate was pretreatment beta -hCG (P 0.01). Conclusions. Only a select group of patients with low pretreatment beta -hC G titers would be expected to achieve complete response with this regimen. Large randomized studies are required to determine the optimal treatment fo r nonmetastatic gestational trophoblastic neoplasia. (C) 2001 Academic Pres s.