This protocol applies to patients diagnosed with gestational choriocarcinoma whose WHO modified prognostic index score for gestational trophoblastic neoplasm (GTN) reaches 7 or higher, placing them in the high-risk category.
A WHO modified prognostic index score of 7 or more in gestational choriocarcinoma signals high-risk disease. This threshold distinguishes patients who require a fundamentally different treatment strategy from those with low-risk disease (score below 7), for whom single-agent therapy may be appropriate.
High-risk gestational choriocarcinoma is managed with multi-agent chemotherapy. For cases where resistance to prior therapy has been established, several distinct combination regimens are available — the full protocol defines the specific options and their respective indications.
Patients with gestational choriocarcinoma who reach a WHO modified prognostic index score for GTN of 7 or higher should initially be treated with multi-agent chemotherapy.
Consider using single-agent chemotherapy in low-risk (score <7) and multi-agent chemotherapy in high risk (score of 7 or more).
TP-TE (paclitaxel, cisplatin–paclitaxel, etoposide), BEP (bleomycin, etoposide, cisplatin), VIP (etoposide, ifosfamide, cisplatin), ICE (ifosfamide, carboplatin, etoposide), and FAEV (floxuridine, dactinomycin, etoposide, vincristine) are accepted for methotrexate-resistant disease and as third line.
TP-EP can be adopted in methotrexate-resistant gestational choriocarcinoma.
DOI: 10.1136/ijgc-2023-004704
View source ↗