Advances in diagnostics and management of gestational trophoblastic disease

Figure 1

Figure 2

Ongoing clinical trials involving treatment of gestational trophoblastic disease

	Trial Drug Design	Reg. Nr.	Recruitment status
Immunotherapy	Camrelizumab combined with apatinib for recurrent resistant GTN	NCT04047017	Completed
	Pebrolizumab for resistant GTN	NCT04303884	Not yet recruiting
	Camrelizumab combined with apatinib in patients with high-risk GTN	NCT05139095	Not yet recruiting
	Avelumab combined with methotrexate for low-risk GTN	NCT04396223	Recruiting
	Avelumab in chemo-resistant GTN	NCT03135769	Completed
	Camrelizumab combined with bevacizumab in high-risk GTN after combined chemotherapy	NCT04812002	Recruiting
	TRC105 and/or bevacizumab in refractory GTN	NCT02664961	Terminated
Chemotherapy	Paclitaxel plus cisplatin vs EMA-CO in high-risk GTN	NCT02639650	Unknown
	Rescue regimen with MTX vs high-dose MTX protocol in persistent GTN	NCT03280979	Unknown
	Pemetrexed disodium as salvage therapy for failed low-risk GTN	NCT00096187	Terminated
	Dactinomycin in patients with persistent or recurrent low-risk GTN	NCT00003688	Completed
	Single dose MTX vs MTX and Actinomycin-D single dose vs MTX multiple courses	NCT01823315	Unknow
	Biweekly actinomycin-D treatment vs multi-day methotrexate in low-risk GTN	NCT04562558	Recruiting
	Methotrexate vs dactinomycin in low-risk GTN	NCT00003702	Completed
	Methotrexate for prevention of postmolar GTN	NCT01984099	Completed
	Dactinomycin vs methotrexate in low-risk GTN	NCT01535053	Completed
	Chemotherapy vs follow up in hydatidiform mole with lung nodule	NCT03785574	Recruiting
	Pemetrexed in recurrent or persistent low-risk GTN	NCT00190918	Completed
	Methotrexate vs methotrexate plus actinomycin in low-risk GTN patients with score 5-6	NCT03885388	Recruiting
Surgical treatment	Hysteroscopic repeat curettage vs methotrexate in low-risk GTN	NCT03703271	Recruiting
	Total abdominal hysterectomy and methotrexate vs methotrexate plus folinic acid	NCT02606539	Unknown
	Second uterine evacuation vs chemotherapy in low-risk GTN	NCT04756713	Recruiting
	Second curettage in low-risk, non-metastatic GTN	NCT00521118	Completed
	Single evacuation vs double evacuation of mole	NCT01630954	Unknown

FIGO staging and classification for gestational trophoblastic neoplasia24

FIGO stage	Description
I	Gestational trophoblastic tumours strictly confined to the uterine corpus
II	Gestational trophoblastic tumours extending to the adnexa or to the vagina but limited to the genital structures
III	Gestational trophoblastic tumour extending to the lungs and may or may not involve the genital tract.
IV	Gestational trophoblastic tumours extending to all other metastatic sites

Ultrasound characteristics of partial hydatidiform mole (PHM) versus complete hydatidiform mole (CHM)13,16,18

Feature	CHM	PHM
US characteristics	Enlarged uterus filled with a heterogeneous predominantly echogenic mass with several hypoechoic foci (snowstorm appearance), multiple small anechoic cystic spaces varying in size from 1 to 30 mm (cluster of grapes). Theca lutein cysts presenting as multiple large, bilateral, functional ovarian cysts can be present.	Subtler US changes. Hydropic changes of some villi are often not visible before 10 weeks of gestation. Enlarged placenta relative to the size of the uterine cavity with internal cystic changes producing a “Swiss cheese pattern” is often seen. Theca lutein cysts are infrequent.
Foetal parts	Absent, except in the rare event of a CHM with a coexisting diploid twin.	Present as amorphous echoes. If a foetus is formed, it carries a typical spectrum of severe abnormalities. Growth retardation is common.
Colour-Doppler power of the uterus	Variable	Variable

World Health Organization scoring system based on prognostic factors modified as FIGO score24

FIGO score	0	1	2	4
Age	<40	>40	-	-
Antecedent pregnancy	Mole	Abortion	Term
Interval from index pregnancy, months	<4	4–6	7–12	>12
Pretreatment hCG IU/L	<103	>103–104	>104–105	>105
Largest tumour size including uterus, cm	-	3–4	≥5	-
Site of metastases including uterus	Lung	Spleen, kidney	Gastrointestinal tract	Brain, liver
Number of metastases identified	-	1–4	5–8	>8
Previous failed chemotherapy	-	-	Single drug	Two or more drugs