Comparative Effectiveness Of Single-agent Methotrexate And Dactinomycin In Low-risk Gestational Trophoblastic Neoplasia:a Metaanalysis

Objective To evaluate the comparable benefits and risks of methotrexate(MTX)regimen and Dactinomycin(Act-D)regimen in the first-line chemotherapy of low-risk geatational trophoblastic neoplasia(LR-GTN).Method According to the requirements of evidence-based medicine,a series of academic databases such as the Cochrane Library,EMBASE,PubMed,CBM,CNKI,and Wanfang Database was retrieved for randomized controlled trials(RCTs)in relation to the safety and efficacy of first-line single-agent MTX-based and Act-D-based in LR-GTN.The last search was updated on February 28,2018.Stata12.0 software was used for the statistical analyses,calculating the relative ratio(RR),weighted mean difference(WMD)and 95%confidence intervals(CI).The heterogeneity analysis and Sensitivity analysis were enrolling the analysis.Results After extensive search and screening,8 randomized controlled trials met the study eligibility criteria.673 patients were included finally(n=326 in the Act-D regimen group and n=347 in the MTX regimen group),in despite of the drug dosage,the way to administer the medicine,the time interval and the course of treatment.The results of meta-analysis showed that: ? Complete response rate(CR):Act-D regimen is superior to MTX regimen in CR(RR=0.69,95%CI:0.59~0.80,P<0.05),and 5d-IV Act-D regimen was probably more likely to be the most effective treatment for LR-GTN.?Drug resistance:MTX regimen is higher than Act-D regimen in drug resistance(RR=2.49,95%CI:1.54~4.03,P<0.05).?Alopecia:Act-D regimen is higher than MTX regimen in alopecia(RR=0.49,95%CI:0.32~0.75,P<0.05).?Hepatotoxicity:MTX regimen is higher than Act-D regimen in hepatotoxicity(RR=2.26,95%CI:1.05~4.86,P<0.05).?Chemotherapy cycles to primary cure,Nausea,Vomiting,Diarrhoea,Mucositis/stomatitis,Constitutional,Neutropenia Thrombocytopenia,Severe adverse events(G3/4):There were not statistically different between the 2 groups(P>0.05).Conclusion Based on the present study,both of methotrexate and Dctinomycin are safety and effective to the treatment in LR-GTN.Because of higher complete remission rate and lower toxicity,Dctinomycin may be a better option than methotrexate as a first-line chemotherapy agent for LR-GTN patients.