Actinomycin D As Initial Therapy Of Gestational Trophoblastic Disease: A Reevaluation

Twelve patients with nonmetastatic (NMTD) and 20 patients with metastatic trophoblastic disease (MTD) of gestational origin were treated with actinomycin D as primary therapy. Complete, sustained remission was obtained in 100% of the patients with NMTD and 80% of those with MTD. In the metastatic group, 100% of patients in whom no chorio-carcinoma (CCA) was present achieved remission on actinomycin D alone, while only 64% of those with metastatic CCA were cured. The 4 patients who failed to respond to actinomycin D subsequently responded to amethopterin (2 patients) and triple therapy (2 patients). Toxi-city was less than that reported for comparable doses of amethopterin alone, particularly with respect to the liver, making actinomycin D the drug of choice in the presence of impaired liver function.