Comparison of weekly methotrexate regimen versus methotrexate folinic acid 8‐day regimen for treatment of low‐risk gestational trophoblastic neoplasia.

Aim: We aimed to compare weekly methotrexate (MTX) regimen and methotrexate‐folinic acid (MTX‐FA) 8‐day regimen in the first line treatment of low‐risk gestational trophoblastic neoplasia (GTN). Methods: The study included 73 patients with low‐risk GTN according to FIGO risk score (FIGO risk score < 7). All patients received either weekly MTX (30–50 mg/m2 intramuscular weekly) or MTX‐FA 8‐day (MTX 1 mg/kg IV on day 1, 3, 5, and 7, FA 15 mg orally on day 2, 4, 6, and 8 given 24 h after each MTX dose, every 14 days) regimens in the first‐line treatment of low‐risk GTN. The baseline clinicopathological characteristics and treatment outcomes were analyzed retrospectively. Results: The median age of all patients was 29 (18–51) years, and the median FIGO risk score was 3 (1–6). Of the patients recruited, 53 received MTX‐FA 8‐day, and 20 had MTX weekly regimens. There was a significant difference between the two groups with respect to FIGO risk scores (3 [1–6] vs. 2 [1–5], p = 0.023, MTX‐FA 8‐day vs. MTX weekly, respectively). The complete response rate was significantly higher in MTX‐FA 8‐day group compared to MTX weekly group (83% [44/53] vs. 60% [12/20] p = 0.038). In univariate and multivariate regression analyses, only presence of lung metastasis was found to be an independent risk factor for treatment resistance (OR: 3.959, 95% CI 1.105–14.179, p = 0.035). Conclusion: MTX‐FA 8‐day regimen is more effective than weekly MTX regimen in the first line treatment of low‐risk GTN including patients even with higher FIGO risk scores. Treatment resistance may develop especially in patients with lung metastasis. [ABSTRACT FROM AUTHOR]