{"entity":{"id":"paper-gog-174-methotrexate-vs-dactinomycin-low-risk-gtn-jco-2011","kind":"paper","name":"GOG 174: weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia","aka":[],"tldr":"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.\n\nComplete 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.","asOf":"2026-09-18","links":[{"label":"J Clin Oncol 2011","url":"https://doi.org/10.1200/JCO.2010.30.4386"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/21263100/"}],"tags":[],"related":[],"cancers":["low-risk-gtn"],"sections":[],"technologies":[],"targets":[],"drugs":["methotrexate","dactinomycin"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2011,"doi":"10.1200/JCO.2010.30.4386","pmid":"21263100","authors":"Osborne RJ, Filiaci V, Schink JC, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":216},"route":"/key-papers/paper-gog-174-methotrexate-vs-dactinomycin-low-risk-gtn-jco-2011/","neighbours":{"cancer":[{"id":"low-risk-gtn","kind":"cancer","name":"Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6)","route":"/cancers/low-risk-gtn/"}],"drug":[{"id":"dactinomycin","kind":"drug","name":"Dactinomycin (actinomycin D)","route":"/drugs/dactinomycin/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}