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Low-Risk Gestational Trophoblastic Neoplasia in Manitoba: Experience With Alternating Methotrexate and Dactinomycin
  1. Vanessa Carlson, MB, BCh, BAO, FRCSC*,
  2. Leslea Walters, MD, FRCSC*,
  3. Pascal Lambert, MSc,
  4. Erin Dean, MD, FRCSC*,,
  5. Robert Lotocki, MD, FRCSC*, and
  6. Alon D. Altman, MD, FRCSC*,
  1. *Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba;
  2. Department of Epidemiology, and
  3. Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
  1. Address correspondence and reprint requests to Alon D. Altman, MD, FRCSC, RS406 810 Sherbrook St, Winnipeg, Manitoba, Canada, R3A 1R9. E-mail: alon.altman{at}


Objectives The aim of this study was to review the treatment and outcomes of low-risk gestational trophoblastic neoplasia (GTN) in Manitoba over more than 3 decades, with a focus on those treated with alternating methotrexate and dactinomycin, a protocol that has only rarely been described.

Materials and Methods We retrospectively reviewed all patients with GTN referred to CancerCare Manitoba from January 1977 to December 2012. Cases were classified as low risk as per the modified WHO-FIGO prognostic scoring system (score, ⩽6). Demographic, treatment, and outcomes data were abstracted, and descriptive statistics and time-to-event analysis were performed. The low-risk protocol used at CancerCare Manitoba consists of alternating single-agent use of methotrexate and dactinomycin, each for 5 days, on a 14-day cycle.

Results Sixty-seven cases of GTN were identified, of which 52 were low risk. Thirty-nine patients were initiated on alternating methotrexate and dactinomycin. Thirty-four (87.2%) achieved primary cure on this regimen, with a median of 4.4 cycles administered (range, 2–7). Median time to response was 56 days. One patient achieved cure after receiving a repeat course of methotrexate as their final cycle. Second-line multiagent chemotherapy was required by 4 patients. Two patients experienced grade 3 toxicities, and none greater than grade 3. There were no recurrences.

Conclusions Alternating methotrexate and dactinomycin is an effective treatment protocol for low-risk GTN, with high rates of primary cure and acceptable toxicity.

  • low-risk gestational trophoblastic neoplasia; methotrexate; dactinomycin

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  • Vanessa Carlson is currently affiliated with the Division of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.

  • Sources of support: V.C. and L.W. received a grant from the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, for the work under consideration for publication. No funds were from a third party.