Comparison of Chemotherapies with Methotrexate, VP-16 and Actinomycin-D in Low-Risk Gestational Trophoblastic Disease

OBJECTIVE: To compare the efficiency and toxicity of four chemotherapeutic regimens in low-risk gestational trophoblastic disease. METHODS: Since 1974, 247 patients with low-risk gestational trophoblastic disease have been treated with 5-day intramuscular methotrexate (MTX) (conventional MTX), 5-day intravenous drip infusion of VP-16, 5-day intravenous actinomycin-D (Act-D) or 8-day alternating intramuscular MTX-folic acid (MTX-CF) at Chiba University School of Medicine. We compared the primary remission rate, the response of human chorionic gonadotropin and the prevalence of drug toxicities in these 4 regimens. RESULTS: The primary remission rate was 73.6% in the conventional MTX regimen, 90.1% in VP-16, 84.0% in Act-D, and 60.0% in MTX-CF. The primary remission rate was significantly higher in the VP-16 and Act-D regimens than in the conventional MTX and MTX-CF regimens. The response rate was significantly higher in the VP-16 regimen than in the other 3 regimens. The drug toxicity with VP-16 and Act-D was less than that with conventional MTX and MTX-CF regimens. CONCLUSIONS: The VP-16 regimen was highly effective and less toxic for gestational trophoblastic disease compared with other chemotherapeutic regimens.