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EPV281/#407 Single-dose methotrexate in the treatment of low-risk gestational trophoblastic neoplasia – an updated Results
  1. SF Ngu,
  2. KY Tse,
  3. MYM Chu,
  4. PNH Sheung and
  5. KLK Chan
  1. The University of Hong Kong, Queen Mary Hospital, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong PRC


Objectives Low-risk gestational trophoblastic neoplasia (GTN) with WHO prognostic score of 0 to 6 has high cure rate. The aim of the study was to evaluate the effectiveness of single-dose methotrexate infusion in women with low-risk GTN.

Methods In this single centre retrospective cohort study, 115 women with low-risk GTN were treated between January 2000 and October 2019 with an intravenous bolus of 100 mg/m2 of methotrexate followed by a 12-hour infusion of 200 mg/m2. Serum human chorionic gonadotropin (hCG) levels were monitored weekly. If the hCG level dropped by 10-fold after 2 weeks, no further chemotherapy was given. Otherwise, chemotherapy was continued 2-weekly until 3 cycles post-normalisation of hCG. Characteristics between the 2 groups with or without complete remission with this regimen were compared.

Results All 115 women with low-risk GTN were cured. The overall complete remission rate with methotrexate was 85.2%, with 60.9% of women requiring a single-dose of methotrexate alone, and 24.3% requiring continuation of chemotherapy with 2-weekly methotrexate. 14.8% of women had unsatisfactory response with methotrexate alone and were cured with combination of methotrexate and actinomycin-D. The pre-treatment hCG levels were significantly lower in women who were cured with single-dose methotrexate regimen compared to those who failed this regimen (median hCG 1227 versus 3335 IU/L; P = 0.037).

Conclusions Single-dose methotrexate regimen offers an effective option for women with low-risk GTN and a low pre-treatment hCG level.

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