International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2026
Comparison of efficacy and toxicity of 2 dactinomycin (ACTD) regimens in the second-line treatment of low-risk gestational trophoblastic neoplasia: a retrospective study.
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Coopmans Leonoor T A, van Trommel Nienke E, Balduzzi Sara, Aguiar Xianne, Charfare Firas, Ghorani Eshan, Caldwell Reece, Kaur Baljeet, Sarwar Naveed, Lok Christianne A R, Seckl Michael J
Аннотация
OBJECTIVE: Low-risk gestational trophoblastic neoplasia is treated with single-agent chemotherapy. Methotrexate is often used as a first-line therapy but is switched to dactinomycin in the event of resistance or toxicity. However, it is unclear whether the currently favored single-pulse 1-day dactinomycin is equally effective as when given daily for 5 days (5-day dactinomycin), both repeated every 2 weeks. The aim of this study was to assess the differences in remission, resistance, recurrence, and chemotoxicity rates between the 5-day and 1-day dactinomycin regimens.
METHODS: A retrospective study using the database of the Charing Cross Centre for Gestational Trophoblastic Disease. Patients who were treated with dactinomycin as second-line treatment for low-risk gestational trophoblastic neoplasia between 2005 and 2020 were selected. Multi-variable analysis was used to identify factors associated with resistance and recurrence.
RESULTS: A total of 324 patients were included, of whom 180 received 5-day dactinomycin and 144 1-day dactinomycin. Remission was achieved in 93.3% (168/180) and 91.7% (132/144) of patients in the 5-day and 1-day dactinomycin groups (p =.914; odds ratio 0.95, 95% confidence interval 0.35 to 2.54), respectively. Resistance to treatment developed in 6.7% (12/180) and 8.3% (12/144) of patients in the 5-day dactinomycin and 1-day dactinomycin groups (p =.914; odds ratio 0.95, 95% confidence interval 0.35 to 2.54), respectively. Overall, recurrences occurred in 5.6% (18/324) of patients, including 4.8% (8/168) after the 5-day dactinomycin regimen and 7.6% (10/132) following the 1-day dactinomycin (p =.24; odds ratio 1.80, 95% confidence interval 0.68 to 4.72). Though the incidence of overall chemotoxicity was similar in both groups, mucositis was significantly higher in patients receiving the 5-day dactinomycin group (95% confidence interval in this test, p <.001). Moreover, patients receiving the 5-day dactinomycin regimen required more dose reductions due to chemotoxicity, and this regimen was more costly to deliver.
CONCLUSIONS: There is no significant difference in remission or subsequent recurrence rates between the 5-day and 1-day dactinomycin regimens. The 1-day dactinomycin regimen is associated with increased patient convenience, with less toxicity and hospital visits, and is therefore more cost-effective.
METHODS: A retrospective study using the database of the Charing Cross Centre for Gestational Trophoblastic Disease. Patients who were treated with dactinomycin as second-line treatment for low-risk gestational trophoblastic neoplasia between 2005 and 2020 were selected. Multi-variable analysis was used to identify factors associated with resistance and recurrence.
RESULTS: A total of 324 patients were included, of whom 180 received 5-day dactinomycin and 144 1-day dactinomycin. Remission was achieved in 93.3% (168/180) and 91.7% (132/144) of patients in the 5-day and 1-day dactinomycin groups (p =.914; odds ratio 0.95, 95% confidence interval 0.35 to 2.54), respectively. Resistance to treatment developed in 6.7% (12/180) and 8.3% (12/144) of patients in the 5-day dactinomycin and 1-day dactinomycin groups (p =.914; odds ratio 0.95, 95% confidence interval 0.35 to 2.54), respectively. Overall, recurrences occurred in 5.6% (18/324) of patients, including 4.8% (8/168) after the 5-day dactinomycin regimen and 7.6% (10/132) following the 1-day dactinomycin (p =.24; odds ratio 1.80, 95% confidence interval 0.68 to 4.72). Though the incidence of overall chemotoxicity was similar in both groups, mucositis was significantly higher in patients receiving the 5-day dactinomycin group (95% confidence interval in this test, p <.001). Moreover, patients receiving the 5-day dactinomycin regimen required more dose reductions due to chemotoxicity, and this regimen was more costly to deliver.
CONCLUSIONS: There is no significant difference in remission or subsequent recurrence rates between the 5-day and 1-day dactinomycin regimens. The 1-day dactinomycin regimen is associated with increased patient convenience, with less toxicity and hospital visits, and is therefore more cost-effective.