This protocol applies to gestational trophoblastic neoplasia (GTN) following a complete molar pregnancy in women classified as low risk by the FIGO 2000 scoring system — where the initial single-agent treatment has not achieved normalisation of hCG and escalation is required.
Women are assessed before chemotherapy using the FIGO 2000 scoring system. A score of 6 or less places a patient in the low-risk group. Approximately 70% of women with a low-risk mole scoring 5 or 6 will ultimately require escalation to multi-agent treatment to eliminate their disease.
The prior regimen — single-agent intramuscular methotrexate alternating daily with folinic acid — did not achieve the required endpoint: return of the hCG level to normal followed by a further 6 consecutive weeks of treatment. Non-achievement of that goal is the trigger for escalation to this protocol.
Intravenous multi-agent chemotherapy is the indicated approach at this stage. The complete regimen, drug combinations, and continuation rules are set out in the structured protocol — only a partial overview is given here.
Return of the hCG level to normal, after which treatment continues for a further 6 consecutive weeks.
DOI: 10.1111/1471-0528.16266