Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic Neoplasia
Methotrexate (MTX) is frequently used as first-line treatment for low-risk gestational trophoblastic neoplasia (GTN). Intravenous and intramuscular (im) routes of administration are the most common methods, although oral administration is used by some Scandinavian centers. The primary aim of this st...
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| Format: | Article |
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MDPI AG
2022-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/3/852 |
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| author | Emelie Wallin Isa Niemann Louise Faaborg Lars Fokdal Ulrika Joneborg |
| author_facet | Emelie Wallin Isa Niemann Louise Faaborg Lars Fokdal Ulrika Joneborg |
| author_sort | Emelie Wallin |
| collection | DOAJ |
| description | Methotrexate (MTX) is frequently used as first-line treatment for low-risk gestational trophoblastic neoplasia (GTN). Intravenous and intramuscular (im) routes of administration are the most common methods, although oral administration is used by some Scandinavian centers. The primary aim of this study was to assess the impact of form of administration (im/oral) on resistance to methotrexate (MTX-R) treatment in low-risk GTN. Secondary aims were time to hCG normalization, rates of toxicity-induced treatment switch, and rates of complete remission and recurrence. In total, 170 women treated at Karolinska University Hospital in Sweden and Aarhus University Hospital in Denmark between 1994 and 2018 were included, of whom 107 were given im and 63 oral MTX. MTX-R developed in 35% and 54% in the im and oral groups, respectively (<i>p</i> = 0.01). There was no difference in days to hCG normalization (42 vs. 41 days, <i>p</i> = 0.50) for MTX-sensitive women. Toxicity-induced treatment switch was only seen in the im group. Complete remission was obtained in 99.1% and 100% (<i>p</i> = 0.44), and recurrence rate within one year was 2.8% and 1.6% (<i>p</i> = 0.29). The form of administration of MTX had a significant impact on development of MTX-R and treatment-associated toxicity, but does not affect rates of complete remission, recurrence or survival. |
| first_indexed | 2024-03-10T00:05:13Z |
| format | Article |
| id | doaj.art-56fbc4a8cdfe4d0a89dfc2e18ebce870 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T00:05:13Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-56fbc4a8cdfe4d0a89dfc2e18ebce8702023-11-23T16:09:44ZengMDPI AGCancers2072-66942022-02-0114385210.3390/cancers14030852Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic NeoplasiaEmelie Wallin0Isa Niemann1Louise Faaborg2Lars Fokdal3Ulrika Joneborg4Department of Women’s and Children’s Health, Karolinska Institutet, 171 21 Stockholm, SwedenDepartment of Clinical Medicine, Aarhus University, 8200 Aarhus, DenmarkDepartment of Oncology, Vejle Hospital, 7100 Vejle, DenmarkDepartment of Oncology, Aarhus University Hospital, 8200 Aarhus, DenmarkDepartment of Women’s and Children’s Health, Karolinska Institutet, 171 21 Stockholm, SwedenMethotrexate (MTX) is frequently used as first-line treatment for low-risk gestational trophoblastic neoplasia (GTN). Intravenous and intramuscular (im) routes of administration are the most common methods, although oral administration is used by some Scandinavian centers. The primary aim of this study was to assess the impact of form of administration (im/oral) on resistance to methotrexate (MTX-R) treatment in low-risk GTN. Secondary aims were time to hCG normalization, rates of toxicity-induced treatment switch, and rates of complete remission and recurrence. In total, 170 women treated at Karolinska University Hospital in Sweden and Aarhus University Hospital in Denmark between 1994 and 2018 were included, of whom 107 were given im and 63 oral MTX. MTX-R developed in 35% and 54% in the im and oral groups, respectively (<i>p</i> = 0.01). There was no difference in days to hCG normalization (42 vs. 41 days, <i>p</i> = 0.50) for MTX-sensitive women. Toxicity-induced treatment switch was only seen in the im group. Complete remission was obtained in 99.1% and 100% (<i>p</i> = 0.44), and recurrence rate within one year was 2.8% and 1.6% (<i>p</i> = 0.29). The form of administration of MTX had a significant impact on development of MTX-R and treatment-associated toxicity, but does not affect rates of complete remission, recurrence or survival.https://www.mdpi.com/2072-6694/14/3/852low risk gestational trophoblastic neoplasiaoral methotrexatemethotrexate treatmentmethotrexate resistance |
| spellingShingle | Emelie Wallin Isa Niemann Louise Faaborg Lars Fokdal Ulrika Joneborg Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic Neoplasia Cancers low risk gestational trophoblastic neoplasia oral methotrexate methotrexate treatment methotrexate resistance |
| title | Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic Neoplasia |
| title_full | Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic Neoplasia |
| title_fullStr | Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic Neoplasia |
| title_full_unstemmed | Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic Neoplasia |
| title_short | Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic Neoplasia |
| title_sort | differences in administration of methotrexate and impact on outcome in low risk gestational trophoblastic neoplasia |
| topic | low risk gestational trophoblastic neoplasia oral methotrexate methotrexate treatment methotrexate resistance |
| url | https://www.mdpi.com/2072-6694/14/3/852 |
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