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Methotrexate or Dactinomycin in Treating Patients With Low-Risk Gestational Trophoblastic Neoplasia

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2014 by Gynecologic Oncology Group
Information provided by (Responsible Party):
Gynecologic Oncology Group Identifier:
First received: February 14, 2012
Last updated: March 25, 2014
Last verified: March 2014

This randomized phase III trial studies how well methotrexate works compared to dactinomycin in treating patients with low-risk gestational trophoblastic neoplasia. Drugs used in chemotherapy, such as methotrexate and dactinomycin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether methotrexate is more effective than dactinomycin in treating gestational trophoblastic disease.

Condition Intervention Phase
Gestational Trophoblastic Tumor
Hydatidiform Mole
Low Risk Metastatic Gestational Trophoblastic Tumor
Uterine Choriocarcinoma
Drug: leucovorin calcium
Biological: dactinomycin
Drug: methotrexate
Procedure: quality-of-life assessment
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase III Randomized Trial of Pulse Actinomycin-D Versus Multi-Day Methotrexate for the Treatment of Low-Risk Gestational Trophoblastic Neoplasia

Resource links provided by NLM:

Further study details as provided by Gynecologic Oncology Group:

Primary Outcome Measures:
  • Complete response vs treatment failure [ Time Frame: Up to 2 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Severity of adverse events as assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events version 4 [ Time Frame: Up to 2 years ] [ Designated as safety issue: Yes ]
  • Overall QOL [ Time Frame: Up to 26 weeks ] [ Designated as safety issue: No ]
    The FACT-G scale will be used to measure the overall QOL and is considered the primary QOL endpoint.

Estimated Enrollment: 384
Study Start Date: June 2012
Estimated Primary Completion Date: August 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm I (leucovorin calcium and methotrexate)
Patients receive methotrexate IM on days 1, 3, 5, and 7 and leucovorin calcium PO on days 2, 4, 6, and 8 OR single-agent methotrexate IV on days 1-5.
Drug: leucovorin calcium
Given PO
Other Names:
  • CF
  • CFR
  • LV
Drug: methotrexate
Given IV and IM
Other Names:
  • amethopterin
  • Folex
  • methylaminopterin
  • Mexate
  • MTX
Procedure: quality-of-life assessment
Ancillary studies
Other Name: quality of life assessment
Active Comparator: Arm II (dactinomycin)
Patients receive dactinomycin IV over 15 minutes on day 1.
Biological: dactinomycin
Given IV
Other Names:
  • ACT-D
  • actinomycin C1
  • AD
  • Cosmegen
  • DACT
Procedure: quality-of-life assessment
Ancillary studies
Other Name: quality of life assessment

Detailed Description:


I. To test the hypothesis that treatment with multi-day methotrexate is inferior to treatment with pulse actinomycin-D (dactinomycin) in patients with low-risk gestational trophoblastic disease with respect to complete response.


I. To describe the frequency of post protocol surgical treatment for each arm. II. To describe the frequency of post protocol multi-agent chemotherapy treatment for each arm.

III. To compare multi-day methotrexate to actinomycin-D with respect to frequency and severity of adverse events in patients with low-risk gestational trophoblastic neoplasia.

IV. To investigate the impact of treatment on overall quality-of-life (QOL) and explore the influence of treatment on issues such as body image, sexual functioning, and patient-reported side effects and disruption.

V. To assess whether uterine artery pulsatility index (UAPI) can provide independent prognostic information predictive of single-drug resistance.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive methotrexate intramuscularly (IM) on days 1, 3, 5, and 7 and leucovorin calcium orally (PO) on days 2, 4, 6, and 8 OR single-agent methotrexate IV on days 1-5.

ARM II: Patients receive dactinomycin IV over 15 minutes on day 1. In both arms, treatment repeats every 14 days for up to 20 courses* in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up monthly for 1 year and then every 3 months for 1 year.

NOTE: * Patients will be treated for three courses after hCG < 5 mIU/mL or until evidence of treatment failure (biologic progression), disease progression, or unacceptable toxicity despite dose modifications. Upon normalization of hCG (< 5 mIU/mL), patients will be treated with three additional courses.


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients who meet International Federation of Gynecology and Obstetrics (FIGO) stage I, II, or III criteria for low-risk gestational trophoblastic neoplasia (GTN): post molar GTN or choriocarcinoma (as defined below); patients may have had a second curettage but must still meet GTN criteria below:

    • Post Molar GTN

      • For the purposes of this study, patients must have undergone evacuation of a complete or partial hydatidiform mole and then meet the criteria for GTN defined as:

        • A < 10% decrease in the human chorionic gonadotropin (hCG) level using as a reference the first value in the series of 4 values taken over a period of 3weeks (> 50 mIU/ml minimum) OR
        • A > 20% sustained rise in the hCG taking as a reference the first value in the series of 3 values taken over a period of 2 weeks (> 50 mIU/ml minimum) OR
        • A persistently elevated hCG level a period of 6 months or more following the initial curettage (> 50 mIU/ml minimum)
    • Choriocarcinoma

      • Histologically proven non-metastatic choriocarcinoma OR
      • Histologically proven metastatic choriocarcinoma if the metastatic site(s) is restricted to one (or more) of the following: vagina, parametrium, or lung
  • World Health Organization (WHO) risk score 0-6
  • Patients must be willing to practice effective contraception for the duration of the study
  • White blood cell count (WBC) >= 3,000 cells/mcL
  • Granulocytes >= 1,500/mcL
  • Platelets >= 100,000/mcL
  • Creatinine =< 2.0 mg/dcL
  • Bilirubin =< 1.5 times institutional normal
  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 times institutional normal
  • Alkaline phosphatase =< 3 times institutional normal
  • Patients must have signed an approved informed consent and authorization permitting release of personal health information
  • No patients with non-gestational choriocarcinoma
  • No patients who have previously been treated with cytotoxic chemotherapy; however, patients who received prior low-dose methotrexate for treatment of an ectopic pregnancy will be eligible for this study
  • No patients who have received prior pelvic radiation
  • No patients with placental-site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT)
  • No patients with Gynecologic Oncology Group (GOG) performance status of 3 or 4
  • Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer, are excluded if there is any evidence of other malignancy being present within the last five years
  • No patients whose circumstances at the time of study entry do not permit completion of the study or required follow-up
  • No patients who wish to breast-feed during treatment
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01535053

  Show 155 Study Locations
Sponsors and Collaborators
Gynecologic Oncology Group
Principal Investigator: Julian Schink Gynecologic Oncology Group
  More Information

No publications provided

Responsible Party: Gynecologic Oncology Group Identifier: NCT01535053     History of Changes
Other Study ID Numbers: GOG-0275, NCI-2012-00250, CDR0000725211, GOG-0275, GOG-0275, U10CA027469
Study First Received: February 14, 2012
Last Updated: March 25, 2014
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Pregnancy Complications, Neoplastic
Gestational Trophoblastic Disease
Hydatidiform Mole
Trophoblastic Neoplasms
Neoplasms by Histologic Type
Neoplasms, Germ Cell and Embryonal
Neoplasms, Glandular and Epithelial
Pregnancy Complications
Abortifacient Agents
Abortifacient Agents, Nonsteroidal
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antirheumatic Agents
Dermatologic Agents
Enzyme Inhibitors
Folic Acid Antagonists
Growth Substances processed this record on November 25, 2014