Home-based treatment of low-risk gestational trophoblastic neoplasia with 8-day methotrexate/folinic acid

To compare the effectiveness and safety of home-based versus hospital-based chemotherapy with 8-day methotrexate/folinic acid (MTX/FA) for low-risk gestational trophoblastic neoplasia (GTN).

Retrospective multiple-cohort study with patients receiving first-line MTX/FA for low-risk GTN at either the Botucatu Trophoblastic Disease Center-UNESP, Brazil (home-based treatment - 80 patients) or the New England Trophoblastic Disease Center, USA (hospital-based treatment - 61 patients), from 1995 to 2020. Follow-up was ≥12 months. Study variables were pre-treatment hCG, FIGO staging/risk score, sustained complete response, failure due to resistance/recurrence/toxicity, number of chemotherapy cycles, time to remission, and survival.

There was no significant difference between treatment settings regarding pre-treatment hCG, GTN stage, sustained complete remission rate (home: 72.5 %, vs. hospital: 78.7 %, p = 0.52), resistance rate (home: 20 % vs. hospital: 15 %, p = 0.56), and rate of toxicity requiring a shift in single-agent chemotherapy (home: 3.5 % vs. hospital: 3.3 %, p = 1.00). The remission rate remained consistent after multivariate adjustment for age and FIGO risk score. However, there was a significant difference in median risk score (home: 2 vs. hospital: 1, p < 0.01) and median number of cycles (home: 3 cycles vs. hospital: 2 cycles; p < 0.01). Time to remission was 14 days longer with home treatment (home: 57 days vs. hospital: 41 days; p < 0.01). All patients survived.

Home- and hospital-based treatments showed similar sustained complete remission rate, with no change in frequency of toxicity-related failure and survival. Low-risk GTN treatment with 8-day-MTX/FA at home is feasible, produces outcomes similar to those observed in a hospital setting and offers a more flexible and patient-centered approach to care.