Effectiveness and Efficiency Comparison of One-Day vs Eight-Day Methotrexate Protocols in Managing Low-Risk Gestational Trophoblastic Neoplasia.

Abstract

Gestational Trophoblastic Neoplasia (GTN) has a high incidence in Bandung, Indonesia, with a mortality rate between 31% and 51%. The most common type is low-risk GTN with various treatment protocols available. The 8-day Methotrexate (MTX) 50 mg protocol has been implemented at our center; however, due to limitation of government insurance, this study aims to compare its effectiveness against the 1-day Methotrexate (MTX) 300 mg/m² protocol. A retrospective cohort study compared two protocols for low-risk GTN treatment at Dr. Hasan Sadikin General Hospital from January 2020 to December 2023: a 1-day Methotrexate (MTX) 300 mg/m² protocol and an 8-day MTX protocol (50 mg MTX IM on days 1, 3, 5, 7 with folinic acid 15 mg orally 24h after MTX on days 2, 4, 6, 8) and repeat every 2weeks. Data on patient characteristics, chemotherapy response, side effects, and treatment costs were analyzed. The 1-day MTX 300 mg/m² protocol achieved similar remission with fewer cycles, milder side effects, and reduced costs compared to the 8-day MTX 50 mg protocol, supporting it as an effective treatment option for low-risk GTN. The 1-day MTX 300 mg/m² protocol is as an effective treatment option for low-risk GTN compared to the 8-day MTX 50 mg protocol.