Gestational trophoblastic neoplasia - Chemotherapy

• Score ≤ 6 = Low risk. 
- Treat with single agent methotrexate alternating daily with folinic acid for 1 week followed by 6 rest days. 
- Cure rate ~100%


• Score ≥ 7 = High risk. 
- Treat with multi-agent chemotherapy MAC (methotrexate, actinomycin D, and cyclophosphamide). 
- Treat until HCG levels normalise then for a further 6 consecutive weeks. 
- Cure rate 95%


• Approximately 90% of patients who want to become pregnant following chemotherapy have succeeded and there is no evidence of increase in foetal abnormalities.

• Women undergoing chemotherapy are advised not to conceive for 1 year after completion of treatment

• Chemotherapy is associated with an increased risk of early menopause (1-3 years earlier)

• Women treated with etoposide may be at increased risk of developing secondary cancers