Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease

Howard D. Homesley, John A. Blessing, Mark Rettenmaier, Robert L. Capizzi, Francis J. Major, Leo B. Twiggs

Research output: Contribution to journalArticlepeer-review

81 Scopus citations


Patients with nonmetastatic gestational trophoblastic disease were entered into this Gynecologic Oncology Group study to determine the efficacy, toxicity, and cost-effectiveness of weekly intramuscular (IM) methotrexate. Treatment was initiated with 30 mg/m2 of weekly IM methotrexate. If no major toxicity was encountered, the weekly dose was escalated 5 mg/m2 at three-week intervals until a maximum dose of 50 mg/m2 each week was achieved. Complete response was defined as three normal β-hCG values measured on consecutive weeks. Fifty-one of 63 evaluable patients (81%) had a complete response to weekly IM methotrexate. Duration of therapy ranged from three to 19 weeks, with a median of seven. No major toxicity occurred. Thirteen patients experienced leukopenia at a median of 3300/μL, with a range of 2300-3900. Three patients had platelet nadirs of 66,000, 127,000 and 135,000/μL. Eleven patients with weekly IM methotrexate failure had a complete response after one to eight courses of dactinomycin administered 0.5 mg/m2 intravenously daily for five days; one refused therapy after three courses. Weekly IM methotrexate for nonmetastatic gestational trophoblastic disease is efficacious, minimally toxic, and cost-effective.

Original languageEnglish (US)
Pages (from-to)413-418
Number of pages6
JournalObstetrics and gynecology
Issue number3
StatePublished - Sep 1988

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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