# Gestational trophoblastic neoplasia

Source: https://onco.cc/cancers/gestational-trophoblastic/  
OnCo record `gestational-trophoblastic` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancers that grow from placental tissue after a pregnancy. They make a hormone (hCG) that acts as a perfect blood test, and they were the first solid cancer ever cured by chemotherapy. Immunotherapy now rescues the few that resist drugs.

## Summary

Gestational trophoblastic neoplasia (GTN) follows a molar pregnancy (complete or partial hydatidiform mole) or, less often, any pregnancy, and includes invasive mole, choriocarcinoma, placental-site and epithelioid trophoblastic tumours. Serum hCG tracks disease burden with unique precision, so diagnosis is usually made from a plateau or rise in hCG after molar evacuation without histology. The FIGO 2000 prognostic score separates low-risk (single-agent methotrexate or actinomycin D) from high-risk disease (multi-agent EMA-CO), with ultra-high-risk patients started on low-dose induction etoposide-cisplatin to prevent early death.

GTN is highly immunogenic (paternal antigens, PD-L1 expression), and PD-1 blockade produced durable complete remissions in chemotherapy-resistant disease (pembrolizumab, Ghorani 2017; avelumab TROPHIMMUN 2020), now in guidelines. Placental-site and epithelioid tumours are chemo-resistant and treated by hysterectomy. Outcomes depend on centralised care with hCG registries (Charing Cross, Sheffield, Brewer).

## Fields

- Kind: Cancer
- Last checked: 2026-09-08
- Also known as: GTN; Choriocarcinoma; Molar pregnancy; Placental site trophoblastic tumour; Gestational Trophoblastic Disease
- Tags: gap-fill; gynaecologic; rare
- Group: gynaecologic
- Burden: Molar pregnancy in ~1 per 1,000 pregnancies (higher in Asia); GTN requiring chemotherapy in ~1 per 40,000 pregnancies; cure rates approach 100% in low-risk and >90% in high-risk disease.
- Subtypes: Complete and partial hydatidiform mole (premalignant); Invasive mole; Gestational choriocarcinoma; Placental-site trophoblastic tumour (PSTT); Epithelioid trophoblastic tumour (ETT)
- Biomarkers: Serum hCG (diagnosis, staging, response, surveillance); FIGO 2000 prognostic score (low ≤6, high ≥7, ultra-high ≥13); Hyperglycosylated hCG / hCG-free beta (PSTT); Genotyping to confirm gestational origin; PD-L1 (expressed in nearly all GTN)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/gestational-trophoblastic/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/gestational-trophoblastic/#overview [3 subtypes, 3 state-of-the-art points]
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/gestational-trophoblastic/#what-it-is [8 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/gestational-trophoblastic/#finding-it [5 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/gestational-trophoblastic/#treating-it [4 settings, 4 decisions with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/gestational-trophoblastic/#evidence [1 trial, 1 key paper, 6 milestones]
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/gestational-trophoblastic/#science [3 targets, 1 pathway]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/gestational-trophoblastic/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/gestational-trophoblastic/#living-with-it [17 questions, 6 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/gestational-trophoblastic/coming/ [8 medicines, 1 trial, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/gestational-trophoblastic/data/ [35 connected records]

## Standard of care

- Low-risk GTN (FIGO score 0-6): Single-agent methotrexate (8-day regimen) or pulsed actinomycin D; switch agent on resistance; consolidate 3 cycles after hCG normalisation. ([Methotrexate](https://onco.cc/drugs/methotrexate/), [Dactinomycin (actinomycin D)](https://onco.cc/drugs/dactinomycin/))
- High-risk GTN (score ≥7): EMA-CO (etoposide, methotrexate, actinomycin D / cyclophosphamide, vincristine); induction low-dose EP for ultra-high-risk; EP-EMA or TP/TE at relapse; surgery for resistant foci. ([Etoposide](https://onco.cc/drugs/etoposide/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Dactinomycin (actinomycin D)](https://onco.cc/drugs/dactinomycin/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Vincristine](https://onco.cc/drugs/vincristine/), [Cisplatin](https://onco.cc/drugs/cisplatin/))
- Chemotherapy-resistant GTN: PD-1/PD-L1 blockade (pembrolizumab, avelumab), high-dose chemotherapy with stem-cell rescue in selected cases, hysterectomy or metastasectomy. ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Avelumab](https://onco.cc/drugs/avelumab/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/))
- PSTT / ETT: Hysterectomy; platinum-etoposide chemotherapy if metastatic or >4 years from antecedent pregnancy. ([Cisplatin](https://onco.cc/drugs/cisplatin/), [Etoposide](https://onco.cc/drugs/etoposide/))

## State of the art

- The only cancer routinely diagnosed and monitored by a hormone alone, with near-universal cure.
- Immunotherapy cures a majority of drug-resistant cases; trials (TROPHAMET, TROPHIMMUN) now test it earlier to avoid chemotherapy.
- Centralised registries remain the model for how rare cancers should be managed.

## Open problems

- Late diagnosis where hCG surveillance after molar pregnancy is absent (much of the world).
- Fertility and psychological burden of a pregnancy-related cancer.
- PSTT/ETT chemo-resistance.
- Cumulative etoposide exposure and second cancers.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease
- NCCN Guidelines: GTN: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1489
- NCI PDQ: GTD: https://www.cancer.gov/types/gestational-trophoblastic/patient/gtd-treatment-pdq

## Connected records

- technologies: [AFP, hCG and LDH in germ cell tumours (IGCCCG risk groups)](https://onco.cc/technologies/germ-cell-tumour-markers/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/), [Serum tumour markers: proper use and misuse](https://onco.cc/technologies/serum-tumour-markers/), [Ultrasound](https://onco.cc/technologies/ultrasound/)
- targets: [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/)
- drugs: [Avelumab](https://onco.cc/drugs/avelumab/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Dactinomycin (actinomycin D)](https://onco.cc/drugs/dactinomycin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Vincristine](https://onco.cc/drugs/vincristine/)
- companies: [Merck & Co. (MSD)](https://onco.cc/companies/merck/), [Pfizer (incl. Seagen)](https://onco.cc/companies/pfizer/)
- pathways: [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/)
- terms: [Cancer during pregnancy](https://onco.cc/terms/cancer-in-pregnancy/), [Rare cancers](https://onco.cc/terms/rare-cancers/)
- journals: [International journal of gynecological cancer](https://onco.cc/journals/international-journal-of-gynecological-cancer/), [Journal of gynecologic oncology](https://onco.cc/journals/journal-of-gynecologic-oncology/)
- cancers: [Choriocarcinoma of the testis](https://onco.cc/cancers/testicular-choriocarcinoma/), [High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk)](https://onco.cc/cancers/high-risk-gtn/), [Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6)](https://onco.cc/cancers/low-risk-gtn/), [Placental-site trophoblastic tumour and epithelioid trophoblastic tumour](https://onco.cc/cancers/placental-site-trophoblastic-tumour/)
- trials: [TROPHIMMUN](https://onco.cc/trials/trophimmun/)
- key papers: [TROPHIMMUN cohort A: avelumab in gestational trophoblastic tumours resistant to single-agent chemotherapy](https://onco.cc/key-papers/paper-trophimmun-avelumab-chemoresistant-gtn-you-jco-2020/)

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JSON: https://onco.cc/api/v1/entities/gestational-trophoblastic.json