Placental-site trophoblastic tumour and epithelioid trophoblastic tumour: lines of therapy

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5 standard-of-care settings across 4 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers
Screening, prevention and diagnosis	1
Advanced, first line	1
Second line	1
Other settings	2

Screening, prevention and diagnosis

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Diagnosis	Expert pathology with immunohistochemistry (human placental lactogen, p63, Ki-67) and genotyping; pelvic MRI, chest CT and FDG-PET; registration with a trophoblastic disease centre.	Histopathology & immunohistochemistryMRICT (computed tomography)PET/CTTumour markers (CEA, LDH, chromogranin, thyroglobulin)	NCCN Guidelines: Gestational Trophoblastic Neoplasia	95

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Metastatic disease or interval over four years	Multi-agent platinum-based chemotherapy (EP-EMA or TP/TE) with resection of residual disease; EMA-CO alone is insufficient.	EtoposideCisplatinMethotrexateDactinomycin (actinomycin D)Paclitaxel / nab-paclitaxelCytotoxic chemotherapy	NCCN Guidelines: Gestational Trophoblastic Neoplasia	99

Second line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Resistant disease	Surgical excision of chemoresistant deposits; high-dose chemotherapy with autologous stem cell rescue in selected cases; pembrolizumab in trials or on a case basis.	Autologous stem cell transplant (high-dose therapy)PembrolizumabPET/CT	NCCN Guidelines: Gestational Trophoblastic Neoplasia	98

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Disease confined to the uterus	Total hysterectomy with ovarian preservation; pelvic node sampling considered; fertility-sparing local resection only in exceptional cases with close follow-up.	Oncofertility and fertility preservationLymphadenectomy (lymph node dissection)	NCCN Guidelines: Gestational Trophoblastic Neoplasia	32
All comers	Follow-up	Clinical review with hCG and imaging, because hCG alone can miss recurrence; prolonged surveillance for late relapse.	Tumour markers (CEA, LDH, chromogranin, thyroglobulin)MRI	NCCN Guidelines: Gestational Trophoblastic Neoplasia	40

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.