# GOG 174: weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia

Source: https://onco.cc/key-papers/paper-gog-174-methotrexate-vs-dactinomycin-low-risk-gtn-jco-2011/  
OnCo record `paper-gog-174-methotrexate-vs-dactinomycin-low-risk-gtn-jco-2011` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In the only large randomised comparison of the two standard single drugs for low-risk GTN, dactinomycin given once a fortnight cured more women than weekly methotrexate, though both were followed by successful rescue in almost everyone.

## Summary

Gynecologic Oncology Group randomised phase 3 trial of 216 eligible women with low-risk gestational trophoblastic neoplasia (WHO score 0 to 6) assigned to weekly intramuscular methotrexate 30 mg/m2 or pulsed intravenous dactinomycin 1.25 mg/m2 every two weeks.

Complete response occurred in 70 percent with dactinomycin against 53 percent with methotrexate; women with a score of 5 to 6 or with choriocarcinoma did poorly with either drug. Nearly all women who failed were cured with subsequent therapy.

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: Journal of Clinical Oncology
- Year: 2011
- DOI: 10.1200/JCO.2010.30.4386
- Authors: Osborne RJ, Filiaci V, Schink JC, et al.
- Findings: Complete response 70 percent with pulsed dactinomycin versus 53 percent with weekly methotrexate.; Response rates were low with either drug in women with WHO scores of 5 to 6 or with choriocarcinoma.
- What it means: Pulsed dactinomycin is at least as good as weekly methotrexate for low-risk GTN, but many centres still prefer the multi-day methotrexate-folinic acid schedule, which was not tested here; overall cure approaches 100 percent whichever drug comes first.
- Caveats: The weekly methotrexate schedule tested is less effective than the eight-day methotrexate-folinic acid regimen used in Europe.; Dactinomycin causes more nausea and alopecia.

## Sources

- J Clin Oncol 2011: https://doi.org/10.1200/JCO.2010.30.4386
- PubMed: https://pubmed.ncbi.nlm.nih.gov/21263100/

## Connected records

- cancers: [Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6)](https://onco.cc/cancers/low-risk-gtn/)
- drugs: [Dactinomycin (actinomycin D)](https://onco.cc/drugs/dactinomycin/), [Methotrexate](https://onco.cc/drugs/methotrexate/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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