A Randomized Phase III Trial of Weekly Parenteral Methotrexate Versus "Pulsed" Dactinomycin as Primary Management for Low Risk Gestational Trophoblastic Neoplasia

Fecha de inicio: 1 de junio de 1999

Inclusion Criteria: * Histologically proven low-risk gestational trophoblastic neoplasia (persistent hydatidiform mole or choriocarcinoma), defined as 1 of the following: * Less than 10% decrease in the beta human chorionic gonadotropin (HCG) titer over 3 weekly titers * Greater than 20% sustained rise in beta HCG titer over two consecutive weeks * Persistently elevated beta HCG titer more than 4 months after initial curettage (greater than 5 mIU/mL minimum) * Histologically proven nonmetastatic choriocarcinoma * Metastases to vagina, parametria, or lung (if no single pulmonary lesion is greater than 2 cm) * WHO score 0-6 (not including blood group or CT lung) * No histologically confirmed placental site pseudotumor * Must have undergone at least 1 uterine curettage * Previously untreated disease * Performance status - GOG 0-2 * WBC at least 3,000/mm\^3 * Granulocyte count at least 1,500/mm\^3 * Platelet count at least 100,000/mm\^3 * Bilirubin no greater than 1.5 times upper limit of normal (ULN) * SGPT and SGOT no greater than 3 times ULN * Alkaline phosphatase no greater than 3 times ULN * No significant prior abnormal hepatic function * Creatinine no greater than 2.0 mg/dL * No significant prior abnormal renal function * Not pregnant or nursing * Fertile patients must use effective contraception during and for one year after study entry * No other prior or concurrent malignancies within the past 5 years except nonmelanomatous skin cancer * No prior chemotherapy for gestational trophoblastic neoplasia * No concurrent curettage except as needed to control vaginal bleeding or to rule out placental site pseudotumor