{"entity":{"id":"gestational-trophoblastic","kind":"cancer","name":"Gestational trophoblastic neoplasia","aka":["GTN","Choriocarcinoma","Molar pregnancy","Placental site trophoblastic tumour","Gestational Trophoblastic Disease"],"tldr":"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.\n\nGTN 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).","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease","links":[{"label":"NCCN Guidelines: GTN","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1489"},{"label":"NCI PDQ: GTD","url":"https://www.cancer.gov/types/gestational-trophoblastic/patient/gtd-treatment-pdq"}],"tags":["gap-fill","gynaecologic","rare"],"related":[],"cancers":[],"sections":[],"technologies":["cytotoxic-chemotherapy","checkpoint-inhibitor","ultrasound","fertility-preservation"],"targets":["pd1","pdl1"],"drugs":["methotrexate","dactinomycin","etoposide","cyclophosphamide","vincristine","cisplatin","pembrolizumab","avelumab"],"companies":["merck","pfizer"],"institutions":[],"pathways":["pd1-checkpoint"],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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)"],"standardOfCare":[{"setting":"Low-risk GTN (FIGO score 0-6)","approach":"Single-agent methotrexate (8-day regimen) or pulsed actinomycin D; switch agent on resistance; consolidate 3 cycles after hCG normalisation.","refs":["methotrexate","dactinomycin"],"guideline":{"nccn":"Category 2A","version":"NCCN Guidelines: Gestational Trophoblastic Neoplasia","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1489"}},{"setting":"High-risk GTN (score ≥7)","approach":"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.","refs":["etoposide","methotrexate","dactinomycin","cyclophosphamide","vincristine","cisplatin"],"guideline":{"nccn":"Category 2A","version":"NCCN Guidelines: Gestational Trophoblastic Neoplasia"}},{"setting":"Chemotherapy-resistant GTN","approach":"PD-1/PD-L1 blockade (pembrolizumab, avelumab), high-dose chemotherapy with stem-cell rescue in selected cases, hysterectomy or metastasectomy.","refs":["pembrolizumab","avelumab","autologous-stem-cell-transplant"],"guideline":{"version":"NCCN 2A; EOTTD guidance"}},{"setting":"PSTT / ETT","approach":"Hysterectomy; platinum-etoposide chemotherapy if metastatic or >4 years from antecedent pregnancy.","refs":["cisplatin","etoposide"]}],"stateOfArt":["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."],"history":[{"year":1956,"title":"Methotrexate cures metastatic choriocarcinoma (Li, Hertz, Spencer)","note":"The first solid tumour cured by chemotherapy.","refs":["methotrexate"]},{"year":1973,"title":"Charing Cross hCG surveillance service established","note":"Model for centralised GTD registries.","refs":[]},{"year":1979,"title":"EMA-CO introduced by Bagshawe for high-risk disease","refs":["etoposide","methotrexate","dactinomycin"]},{"year":2000,"title":"FIGO 2000 staging and prognostic score","refs":[]},{"year":2017,"title":"Pembrolizumab cures chemoresistant GTN (Ghorani, Lancet)","refs":["pembrolizumab"]},{"year":2020,"title":"TROPHIMMUN: avelumab in methotrexate-resistant low-risk GTN","refs":["avelumab"]}],"pipeline":["pembrolizumab","avelumab"],"openProblems":["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."]},"route":"/cancers/gestational-trophoblastic/","neighbours":{"technology":[{"id":"germ-cell-tumour-markers","kind":"technology","name":"AFP, hCG and LDH in germ cell tumours (IGCCCG risk groups)","route":"/technologies/germ-cell-tumour-markers/"},{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","route":"/technologies/autologous-stem-cell-transplant/"},{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"fertility-preservation","kind":"technology","name":"Oncofertility and fertility preservation","route":"/technologies/fertility-preservation/"},{"id":"serum-tumour-markers","kind":"technology","name":"Serum tumour markers: proper use and misuse","route":"/technologies/serum-tumour-markers/"},{"id":"ultrasound","kind":"technology","name":"Ultrasound","route":"/technologies/ultrasound/"}],"target":[{"id":"pd1","kind":"target","name":"PD-1","route":"/targets/pd1/"},{"id":"pdl1","kind":"target","name":"PD-L1","route":"/targets/pdl1/"}],"drug":[{"id":"avelumab","kind":"drug","name":"Avelumab","route":"/drugs/avelumab/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"dactinomycin","kind":"drug","name":"Dactinomycin (actinomycin D)","route":"/drugs/dactinomycin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"company":[{"id":"merck","kind":"company","name":"Merck & Co. (MSD)","route":"/companies/merck/"},{"id":"pfizer","kind":"company","name":"Pfizer (incl. Seagen)","route":"/companies/pfizer/"}],"pathway":[{"id":"pd1-checkpoint","kind":"pathway","name":"PD-1 / PD-L1 immune checkpoint & T-cell activation","route":"/pathways/pd1-checkpoint/"}],"term":[{"id":"cancer-in-pregnancy","kind":"term","name":"Cancer during pregnancy","route":"/terms/cancer-in-pregnancy/"},{"id":"rare-cancers","kind":"term","name":"Rare cancers","route":"/terms/rare-cancers/"}],"journal":[{"id":"international-journal-of-gynecological-cancer","kind":"journal","name":"International journal of gynecological cancer","route":"/journals/international-journal-of-gynecological-cancer/"},{"id":"journal-of-gynecologic-oncology","kind":"journal","name":"Journal of gynecologic oncology","route":"/journals/journal-of-gynecologic-oncology/"}],"cancer":[{"id":"testicular-choriocarcinoma","kind":"cancer","name":"Choriocarcinoma of the testis","route":"/cancers/testicular-choriocarcinoma/"},{"id":"high-risk-gtn","kind":"cancer","name":"High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk)","route":"/cancers/high-risk-gtn/"},{"id":"low-risk-gtn","kind":"cancer","name":"Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6)","route":"/cancers/low-risk-gtn/"},{"id":"placental-site-trophoblastic-tumour","kind":"cancer","name":"Placental-site trophoblastic tumour and epithelioid trophoblastic tumour","route":"/cancers/placental-site-trophoblastic-tumour/"}],"trial":[{"id":"trophimmun","kind":"trial","name":"TROPHIMMUN","route":"/trials/trophimmun/"}],"paper":[{"id":"paper-trophimmun-avelumab-chemoresistant-gtn-you-jco-2020","kind":"paper","name":"TROPHIMMUN cohort A: avelumab in gestational trophoblastic tumours resistant to single-agent chemotherapy","route":"/key-papers/paper-trophimmun-avelumab-chemoresistant-gtn-you-jco-2020/"}]}}