Options mapped
Gestational trophoblastic disease / neoplasia: options by country
Sourced options by country plus visit-prep questions for Gestational trophoblastic disease / neoplasia. Each line links to its regulator, HTA, or guideline source. This page maps options; it does not recommend or rank them.
Options mappedRare diseaseLast checked June 2026
What this page does
Maps options by country
It maps sourced options by country alongside diagnosis wording, stage, test results, specialists, and trial-search terms.
What it does not do
Does not choose treatment
It does not rank treatments, recommend a choice, or decide clinical fit.
Where it comes from
Built on trusted sources
Every option links to a trusted regulator, HTA, or guideline source, and the list grows as new sources pass verification.
Information to gather before the next visit
- What is the exact diagnosis and risk category: low-risk GTN, high-risk metastatic GTN, PSTT, ETT, recurrent, or chemoresistant disease?
- Is beta-hCG monitoring showing response, resistance, or recurrence?
- Is the treatment question single-agent chemotherapy, combination chemotherapy, surgery, brain-directed therapy, or a clinical trial?
- Which UK specialist GTD centre is coordinating care?
Trial-search terms to discuss
Options by country
Treatments by country
Regulatory and access status by country, from official sources. It shows what exists and where — not a recommendation.
United States
- Surgery, single-agent chemotherapy, combination chemotherapy including EMA/CO and other regimens, intrathecal chemotherapy and/or brain radiation in selected metastatic contexts, salvage surgery in selected chemoresistant contexts, clinical trials[1]Standard option (per NCI PDQ)Low-risk GTN; high-risk metastatic GTN; stage I-IV PSTT/ETT; recurrent or chemoresistant GTN. · NCI states there are no randomized trials establishing superiority among commonly used high-risk regimens; EMA/CO is presented because it is commonly used, not because NCI declares it universally superior. Do not infer individual eligibility, dosing, or insurance coverage from this summary. Confidence/conflicts: High for U.S. evidence-framework categories; regimen superiority and individual treatment selection remain uncertain as the source states.
- Surgery, single-agent chemotherapy, combination chemotherapy including EMA/CO and other regimens, intrathecal chemotherapy and/or brain radiation in selected metastatic contexts, salvage surgery in selected chemoresistant contexts, clinical trials[1]Standard option (per NCI PDQ)Low-risk GTN; high-risk metastatic GTN; stage I-IV PSTT/ETT; recurrent or chemoresistant GTN. · NCI states there are no randomized trials establishing superiority among commonly used high-risk regimens; EMA/CO is presented because it is commonly used, not because NCI declares it universally superior. Do not infer individual eligibility, dosing, or insurance coverage from this summary. Confidence/conflicts: High for U.S. evidence-framework categories; regimen superiority and individual treatment selection remain uncertain as the source states.
- Surgery, single-agent chemotherapy, combination chemotherapy including EMA/CO and other regimens, intrathecal chemotherapy and/or brain radiation in selected metastatic contexts, salvage surgery in selected chemoresistant contexts, clinical trials[1]Standard option (per NCI PDQ)Low-risk GTN; high-risk metastatic GTN; stage I-IV PSTT/ETT; recurrent or chemoresistant GTN. · NCI states there are no randomized trials establishing superiority among commonly used high-risk regimens; EMA/CO is presented because it is commonly used, not because NCI declares it universally superior. Do not infer individual eligibility, dosing, or insurance coverage from this summary. Confidence/conflicts: High for U.S. evidence-framework categories; regimen superiority and individual treatment selection remain uncertain as the source states.
- Surgery, single-agent chemotherapy, combination chemotherapy including EMA/CO and other regimens, intrathecal chemotherapy and/or brain radiation in selected metastatic contexts, salvage surgery in selected chemoresistant contexts, clinical trials[1]Standard option (per NCI PDQ)Low-risk GTN; high-risk metastatic GTN; stage I-IV PSTT/ETT; recurrent or chemoresistant GTN. · NCI states there are no randomized trials establishing superiority among commonly used high-risk regimens; EMA/CO is presented because it is commonly used, not because NCI declares it universally superior. Do not infer individual eligibility, dosing, or insurance coverage from this summary. Confidence/conflicts: High for U.S. evidence-framework categories; regimen superiority and individual treatment selection remain uncertain as the source states.
- Surgery, single-agent chemotherapy, combination chemotherapy including EMA/CO and other regimens, intrathecal chemotherapy and/or brain radiation in selected metastatic contexts, salvage surgery in selected chemoresistant contexts, clinical trials[1]Standard option (per NCI PDQ)Low-risk GTN; high-risk metastatic GTN; stage I-IV PSTT/ETT; recurrent or chemoresistant GTN. · NCI states there are no randomized trials establishing superiority among commonly used high-risk regimens; EMA/CO is presented because it is commonly used, not because NCI declares it universally superior. Do not infer individual eligibility, dosing, or insurance coverage from this summary. Confidence/conflicts: High for U.S. evidence-framework categories; regimen superiority and individual treatment selection remain uncertain as the source states.
United Kingdom
- Methotrexate with folinic acid rescue, actinomycin D, EMA-CO, EP-EMA, TP/TE, intrathecal methotrexate in selected brain/high-risk contexts, pembrolizumab for chemotherapy-resistant situations, specialist-center chemotherapy[2]Standard option (per Cancer Research UK)hCG monitoring and risk score are described; no molecular biomarker specified in the fetched source; Low-risk invasive mole/choriocarcinoma; high-risk disease; ultra-high-risk disease; chemotherapy resistance; brain-spread/high-risk intrathecal context. · This is UK cancer information, not a NICE appraisal or individual commissioning decision. Pembrolizumab is described for rare chemotherapy-resistant situations; do not generalize to all GTN or imply automatic access. Confidence/conflicts: High for UK chemotherapy and specialist-center framework; NICE/commissioning specifics were not independently fetched in this finding.
- Methotrexate with folinic acid rescue, actinomycin D, EMA-CO, EP-EMA, TP/TE, intrathecal methotrexate in selected brain/high-risk contexts, pembrolizumab for chemotherapy-resistant situations, specialist-center chemotherapy[2]Standard option (per Cancer Research UK)hCG monitoring and risk score are described; no molecular biomarker specified in the fetched source; Low-risk invasive mole/choriocarcinoma; high-risk disease; ultra-high-risk disease; chemotherapy resistance; brain-spread/high-risk intrathecal context. · This is UK cancer information, not a NICE appraisal or individual commissioning decision. Pembrolizumab is described for rare chemotherapy-resistant situations; do not generalize to all GTN or imply automatic access. Confidence/conflicts: High for UK chemotherapy and specialist-center framework; NICE/commissioning specifics were not independently fetched in this finding.
- Methotrexate with folinic acid rescue, actinomycin D, EMA-CO, EP-EMA, TP/TE, intrathecal methotrexate in selected brain/high-risk contexts, pembrolizumab for chemotherapy-resistant situations, specialist-center chemotherapy[2]Standard option (per Cancer Research UK)hCG monitoring and risk score are described; no molecular biomarker specified in the fetched source; Low-risk invasive mole/choriocarcinoma; high-risk disease; ultra-high-risk disease; chemotherapy resistance; brain-spread/high-risk intrathecal context. · This is UK cancer information, not a NICE appraisal or individual commissioning decision. Pembrolizumab is described for rare chemotherapy-resistant situations; do not generalize to all GTN or imply automatic access. Confidence/conflicts: High for UK chemotherapy and specialist-center framework; NICE/commissioning specifics were not independently fetched in this finding.
- Methotrexate with folinic acid rescue, actinomycin D, EMA-CO, EP-EMA, TP/TE, intrathecal methotrexate in selected brain/high-risk contexts, pembrolizumab for chemotherapy-resistant situations, specialist-center chemotherapy[2]Standard option (per Cancer Research UK)hCG monitoring and risk score are described; no molecular biomarker specified in the fetched source; Low-risk invasive mole/choriocarcinoma; high-risk disease; ultra-high-risk disease; chemotherapy resistance; brain-spread/high-risk intrathecal context. · This is UK cancer information, not a NICE appraisal or individual commissioning decision. Pembrolizumab is described for rare chemotherapy-resistant situations; do not generalize to all GTN or imply automatic access. Confidence/conflicts: High for UK chemotherapy and specialist-center framework; NICE/commissioning specifics were not independently fetched in this finding.
- Monitoring/advisory follow-up, chemotherapy, surgery in selected cases, specialist GTD clinic assessment[3]Standard option (per Imperial College Healthcare NHS Trust)hCG monitoring implied by GTD service follow-up; no molecular biomarker specified in the fetched Imperial page; GTD follow-up/monitoring; cases needing additional treatment; specialist clinic assessment. · This source documents a specialist-service pathway and broad treatment categories, not specific chemotherapy regimens, eligibility, or national commissioning rules. Confidence/conflicts: High for the Charing Cross specialist-service and broad treatment pathway; regimen-level detail should use dedicated treatment sources.
- Monitoring/advisory follow-up, chemotherapy, surgery in selected cases, specialist GTD clinic assessment[3]Standard option (per Imperial College Healthcare NHS Trust)hCG monitoring implied by GTD service follow-up; no molecular biomarker specified in the fetched Imperial page; GTD follow-up/monitoring; cases needing additional treatment; specialist clinic assessment. · This source documents a specialist-service pathway and broad treatment categories, not specific chemotherapy regimens, eligibility, or national commissioning rules. Confidence/conflicts: High for the Charing Cross specialist-service and broad treatment pathway; regimen-level detail should use dedicated treatment sources.
- Monitoring/advisory follow-up, chemotherapy, surgery in selected cases, specialist GTD clinic assessment[3]Standard option (per Imperial College Healthcare NHS Trust)hCG monitoring implied by GTD service follow-up; no molecular biomarker specified in the fetched Imperial page; GTD follow-up/monitoring; cases needing additional treatment; specialist clinic assessment. · This source documents a specialist-service pathway and broad treatment categories, not specific chemotherapy regimens, eligibility, or national commissioning rules. Confidence/conflicts: High for the Charing Cross specialist-service and broad treatment pathway; regimen-level detail should use dedicated treatment sources.
Sources
- National Cancer Institute — national cancer agency evidence summary · national cancer agency evidence summary
- Cancer Research UK — UK cancer information / specialist-center treatment information · UK cancer information / specialist-center treatment information
- Imperial College Healthcare NHS Trust — NHS specialist-service information · NHS specialist-service information
This is official regulatory and access status only — not medical advice, not a recommendation, and not a statement about eligibility. Whether any option fits depends on your situation and your oncology team. Status changes over time; confirm the current position with the linked source. Last checked 2026-06-12.
Beyond approved care
In clinical trials & emerging options
Options that are not — or not yet — an approved standard where you live: studies, clinical trials, off-label use, and early evidence that your own oncologist may not raise. Each is labeled by how strong the evidence is. A listing here is information to research and discuss with your team; it does not mean a treatment is proven, safe for you, or available today.
In clinical trials
- Avelumab plus methotrexate; avelumab; domvanalimab plus zimberelimab with or without FOLFOX-4; French National Reference Centre registry/observational pathwayClinical trial · NCT04396223Clinical trialTrial only (registry)European Union · Low-risk GTN first-line; chemo-resistant GTN; advanced rare-cancer platform including gestational trophoblastic tumor; national reference-centre GTD registry context. · Some records are interventional treatment studies; the French National Reference Centre record is registry/reference-centre context without an intervention listed. Trial participation and reference-centre registry inclusion should not be represented as approved access. Confidence/conflicts: High for France-site registry support; no EMA/ANSM/HAS access claim is made. ClinicalTrials.gov — clinical-trial registry
- Avelumab plus methotrexate; avelumab; domvanalimab plus zimberelimab with or without FOLFOX-4; French National Reference Centre registry/observational pathwayClinical trial · NCT04396223Clinical trialTrial only (registry)European Union · Low-risk GTN first-line; chemo-resistant GTN; advanced rare-cancer platform including gestational trophoblastic tumor; national reference-centre GTD registry context. · Some records are interventional treatment studies; the French National Reference Centre record is registry/reference-centre context without an intervention listed. Trial participation and reference-centre registry inclusion should not be represented as approved access. Confidence/conflicts: High for France-site registry support; no EMA/ANSM/HAS access claim is made. ClinicalTrials.gov — clinical-trial registry
- Avelumab plus methotrexate; avelumab; domvanalimab plus zimberelimab with or without FOLFOX-4; French National Reference Centre registry/observational pathwayClinical trial · NCT04396223Clinical trialTrial only (registry)European Union · Low-risk GTN first-line; chemo-resistant GTN; advanced rare-cancer platform including gestational trophoblastic tumor; national reference-centre GTD registry context. · Some records are interventional treatment studies; the French National Reference Centre record is registry/reference-centre context without an intervention listed. Trial participation and reference-centre registry inclusion should not be represented as approved access. Confidence/conflicts: High for France-site registry support; no EMA/ANSM/HAS access claim is made. ClinicalTrials.gov — clinical-trial registry
- Avelumab plus methotrexate; avelumab; domvanalimab plus zimberelimab with or without FOLFOX-4; French National Reference Centre registry/observational pathwayClinical trial · NCT04396223Clinical trialTrial only (registry)European Union · Low-risk GTN first-line; chemo-resistant GTN; advanced rare-cancer platform including gestational trophoblastic tumor; national reference-centre GTD registry context. · Some records are interventional treatment studies; the French National Reference Centre record is registry/reference-centre context without an intervention listed. Trial participation and reference-centre registry inclusion should not be represented as approved access. Confidence/conflicts: High for France-site registry support; no EMA/ANSM/HAS access claim is made. ClinicalTrials.gov — clinical-trial registry
- Dactinomycin; methotrexate; leucovorin calcium; quality-of-life assessmentClinical trial · NCT01535053Clinical trialTrial only (registry)Japan · Low-risk gestational trophoblastic neoplasia, including choriocarcinoma and FIGO stage I-III gestational trophoblastic tumor/hydatidiform mole contexts in the registry conditions. · The study is completed. Registry location text supports trial participation history in these countries, not current enrollment or local standard-of-care access. Confidence/conflicts: High for country-site and trial-context support; no regulator approval claim is made. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility ClinicalTrials.gov — clinical-trial registry
- Dactinomycin; methotrexate; leucovorin calcium; quality-of-life assessmentClinical trial · NCT01535053Clinical trialTrial only (registry)Japan · Low-risk gestational trophoblastic neoplasia, including choriocarcinoma and FIGO stage I-III gestational trophoblastic tumor/hydatidiform mole contexts in the registry conditions. · The study is completed. Registry location text supports trial participation history in these countries, not current enrollment or local standard-of-care access. Confidence/conflicts: High for country-site and trial-context support; no regulator approval claim is made. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility ClinicalTrials.gov — clinical-trial registry
- Dactinomycin; methotrexate; leucovorin calcium; quality-of-life assessmentClinical trial · NCT01535053Clinical trialTrial only (registry)Japan · Low-risk gestational trophoblastic neoplasia, including choriocarcinoma and FIGO stage I-III gestational trophoblastic tumor/hydatidiform mole contexts in the registry conditions. · The study is completed. Registry location text supports trial participation history in these countries, not current enrollment or local standard-of-care access. Confidence/conflicts: High for country-site and trial-context support; no regulator approval claim is made. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility ClinicalTrials.gov — clinical-trial registry
- Pembrolizumab (Keytruda); pembrolizumab before second evacuation for post-molar GTNClinical trial · NCT04303884Clinical trialTrial only (registry)Korea · Chemo-resistant GTN for the South Korea record; post-molar GTN before second evacuation for the UK record. · Study statuses differ: unknown for the South Korea trial and recruiting for the UK trial. Immunotherapy should not be generalized to all GTN settings from these registry records. Confidence/conflicts: High for registry support; medium for current availability because one study status is unknown and neither source is a regulator/HTA document. ClinicalTrials.gov — clinical-trial registry
- Pembrolizumab (Keytruda); pembrolizumab before second evacuation for post-molar GTNClinical trial · NCT04303884Clinical trialTrial only (registry)Korea · Chemo-resistant GTN for the South Korea record; post-molar GTN before second evacuation for the UK record. · Study statuses differ: unknown for the South Korea trial and recruiting for the UK trial. Immunotherapy should not be generalized to all GTN settings from these registry records. Confidence/conflicts: High for registry support; medium for current availability because one study status is unknown and neither source is a regulator/HTA document. ClinicalTrials.gov — clinical-trial registry
- Methotrexate, methotrexate plus actinomycin-D, actinomycin-D, hysteroscopic repeat curettage, etoposide/actinomycin D/methotrexate/vincristine/cyclophosphamide, paclitaxel/cisplatin/carboplatin, toripalimab plus actinomycin-D, camrelizumab plus apatinib, follow-up/chemotherapy strategyClinical trial · NCT01823315Clinical trialTrial only (registry)China · FIGO score/risk category as specified by individual registry records; no molecular biomarker specified; Low-risk GTN; low-risk postmolar GTN; high-risk gestational trophoblastic tumor; GTN FIGO score 5-6 or 7; recurrent resistant GTN; hydatidiform mole with lung nodule. · Several records have unknown overall status despite site text; one is completed, some are recruiting/active-not-recruiting. Trial records do not equal current standard of care or national approval. Confidence/conflicts: High for China-site registry support; no NMPA approval claim is made. ClinicalTrials.gov — clinical-trial registry
- Methotrexate, methotrexate plus actinomycin-D, actinomycin-D, hysteroscopic repeat curettage, etoposide/actinomycin D/methotrexate/vincristine/cyclophosphamide, paclitaxel/cisplatin/carboplatin, toripalimab plus actinomycin-D, camrelizumab plus apatinib, follow-up/chemotherapy strategyClinical trial · NCT01823315Clinical trialTrial only (registry)China · FIGO score/risk category as specified by individual registry records; no molecular biomarker specified; Low-risk GTN; low-risk postmolar GTN; high-risk gestational trophoblastic tumor; GTN FIGO score 5-6 or 7; recurrent resistant GTN; hydatidiform mole with lung nodule. · Several records have unknown overall status despite site text; one is completed, some are recruiting/active-not-recruiting. Trial records do not equal current standard of care or national approval. Confidence/conflicts: High for China-site registry support; no NMPA approval claim is made. ClinicalTrials.gov — clinical-trial registry
- Methotrexate, methotrexate plus actinomycin-D, actinomycin-D, hysteroscopic repeat curettage, etoposide/actinomycin D/methotrexate/vincristine/cyclophosphamide, paclitaxel/cisplatin/carboplatin, toripalimab plus actinomycin-D, camrelizumab plus apatinib, follow-up/chemotherapy strategyClinical trial · NCT01823315Clinical trialTrial only (registry)China · FIGO score/risk category as specified by individual registry records; no molecular biomarker specified; Low-risk GTN; low-risk postmolar GTN; high-risk gestational trophoblastic tumor; GTN FIGO score 5-6 or 7; recurrent resistant GTN; hydatidiform mole with lung nodule. · Several records have unknown overall status despite site text; one is completed, some are recruiting/active-not-recruiting. Trial records do not equal current standard of care or national approval. Confidence/conflicts: High for China-site registry support; no NMPA approval claim is made. ClinicalTrials.gov — clinical-trial registry
- Methotrexate, methotrexate plus actinomycin-D, actinomycin-D, hysteroscopic repeat curettage, etoposide/actinomycin D/methotrexate/vincristine/cyclophosphamide, paclitaxel/cisplatin/carboplatin, toripalimab plus actinomycin-D, camrelizumab plus apatinib, follow-up/chemotherapy strategyClinical trial · NCT01823315Clinical trialTrial only (registry)China · FIGO score/risk category as specified by individual registry records; no molecular biomarker specified; Low-risk GTN; low-risk postmolar GTN; high-risk gestational trophoblastic tumor; GTN FIGO score 5-6 or 7; recurrent resistant GTN; hydatidiform mole with lung nodule. · Several records have unknown overall status despite site text; one is completed, some are recruiting/active-not-recruiting. Trial records do not equal current standard of care or national approval. Confidence/conflicts: High for China-site registry support; no NMPA approval claim is made. ClinicalTrials.gov — clinical-trial registry
- Methotrexate, methotrexate plus actinomycin-D, actinomycin-D, hysteroscopic repeat curettage, etoposide/actinomycin D/methotrexate/vincristine/cyclophosphamide, paclitaxel/cisplatin/carboplatin, toripalimab plus actinomycin-D, camrelizumab plus apatinib, follow-up/chemotherapy strategyClinical trial · NCT01823315Clinical trialTrial only (registry)China · FIGO score/risk category as specified by individual registry records; no molecular biomarker specified; Low-risk GTN; low-risk postmolar GTN; high-risk gestational trophoblastic tumor; GTN FIGO score 5-6 or 7; recurrent resistant GTN; hydatidiform mole with lung nodule. · Several records have unknown overall status despite site text; one is completed, some are recruiting/active-not-recruiting. Trial records do not equal current standard of care or national approval. Confidence/conflicts: High for China-site registry support; no NMPA approval claim is made. ClinicalTrials.gov — clinical-trial registry
- Methotrexate, methotrexate plus actinomycin-D, actinomycin-D, hysteroscopic repeat curettage, etoposide/actinomycin D/methotrexate/vincristine/cyclophosphamide, paclitaxel/cisplatin/carboplatin, toripalimab plus actinomycin-D, camrelizumab plus apatinib, follow-up/chemotherapy strategyClinical trial · NCT01823315Clinical trialTrial only (registry)China · FIGO score/risk category as specified by individual registry records; no molecular biomarker specified; Low-risk GTN; low-risk postmolar GTN; high-risk gestational trophoblastic tumor; GTN FIGO score 5-6 or 7; recurrent resistant GTN; hydatidiform mole with lung nodule. · Several records have unknown overall status despite site text; one is completed, some are recruiting/active-not-recruiting. Trial records do not equal current standard of care or national approval. Confidence/conflicts: High for China-site registry support; no NMPA approval claim is made. ClinicalTrials.gov — clinical-trial registry
A clinical-trial listing or early report shows an option is being studied — not that it works, that it is safe for any one person, or that a site is enrolling today. Whether any of these fits is a conversation for your oncology team and the trial team. Last checked 2026-06-12.