comparison of the efficacy of methotrexate and actinomycin d in the treatment of patients with stage i low risk gestational tro-phoblastic neoplasia (gtn)

background : gestational trophoblastic neoplasia (gtn) refers to malignant lesions that arise from abnormal proliferation of placental trophoblast. even in its metastatic forms gtn is curable with a cure rate of 90-100 %. currently, methotrexate with or without folic acid, andactinomycin d is recommended for low risk gtn. the aim of this study is to compare the efficacy of methotrexate and actinomycin d as the first-line single chemotherapeutic agents for women with low-risk gestational trophoblastic neoplasia (lr-gtn).   methods: a total of 30 women with lr-gtn were randomized to receive a weekly pulsed dose of 40 mg/m (2) of methotrexate intramuscularly (n=15) or a pulsed intravenous bolus of 1.25 mg/m (2) of actinomycin d every 2 weeks (n=15). an additional cycle was administered as consolidation treatment following normalization of the serum level of beta-human chorionic gonadotropin (˂10 iu/l).   results: complete remission was achieved in 53.3% of patients in the methotrexate group and 86.7% in the actinomycin d group (p˂0.04). the mean number of treatment cycles needed to achieve response was lower in the actinomycin d group (4.3 vs. 6.5). the mean duration from beginning of treatment till achieving complete remission was 9.6 weeks for the act group and 13 weeks for the mtx group.   conclusion: actinomycin d may be a better option than methotrexate as a first-line chemotherapy agent for patients with lr-gtn but larger multicenter randomized controlled trials should be conducted to establish the most appropriate regimen for these patients.