High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk): lines of therapy

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5 standard-of-care settings across 4 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers	Risk group
Screening, prevention and diagnosis	1	·
Early / localised	·	2
Second line	1	·
Special situations	1	·

Screening, prevention and diagnosis

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Staging	hCG, chest CT, brain MRI, abdominal imaging, pelvic Doppler ultrasound and FIGO scoring; genotyping where the antecedent pregnancy is unclear.	CT (computed tomography)MRIUltrasoundTumour markers (CEA, LDH, chromogranin, thyroglobulin)Disease-specific staging and risk systems (FIGO, Ann Arbor, IPI, R-ISS, ELN, IMDC)	NCCN Guidelines: Gestational Trophoblastic Neoplasia	66

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
Risk group	High-risk disease, first line	EMA-CO (etoposide, methotrexate, actinomycin D alternating with cyclophosphamide and vincristine) until hCG normalises plus at least three consolidation cycles.	EtoposideMethotrexateDactinomycin (actinomycin D)CyclophosphamideVincristineCytotoxic chemotherapy	NCCN Guidelines: Gestational Trophoblastic Neoplasia	94
Risk group	Ultra-high-risk disease	Induction low-dose etoposide and cisplatin for one to three cycles before EMA-CO to prevent early death from haemorrhage and organ failure.	EtoposideCisplatin	NCCN Guidelines: Gestational Trophoblastic Neoplasia	81

Second line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Resistant or relapsed disease	EP-EMA or TP/TE; resection of a resistant focus (hysterectomy, lung wedge); pembrolizumab or avelumab; high-dose chemotherapy with autologous rescue in exceptional cases.	EtoposideCisplatinPaclitaxel / nab-paclitaxelPembrolizumabAvelumabAutologous stem cell transplant (high-dose therapy)PET/CT	NCCN Guidelines: Gestational Trophoblastic Neoplasia	98

Special situations

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Brain metastases	High-dose systemic and intrathecal methotrexate within EMA-CO, with whole-brain or stereotactic radiotherapy or craniotomy for bleeding or single lesions.	MethotrexateIMRT / IGRT (modern external beam)SBRT / SABR (stereotactic radiotherapy)	NCCN Guidelines: Gestational Trophoblastic Neoplasia	93

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.