A 28-year-old woman is diagnosed with non-metastatic gestational trophoblastic neoplasia (FIGO Score 4) post-complete mole. She desires future fertility. Which is the FIRST-LINE chemotherapy regimen?
- A EMA/CO (etoposide, methotrexate, actinomycin D / cyclophosphamide, vincristine)
- B Single-agent actinomycin D (dactinomycin) pulsed IV
- C Single-agent methotrexate (MTX) with folinic acid rescue ✓
- D BEP (bleomycin, etoposide, cisplatin)
Correct answer: C. Single-agent methotrexate (MTX) with folinic acid rescue
Explanation
Low-risk GTN (FIGO score ≤6) is treated with single-agent chemotherapy. Methotrexate (with folinic acid rescue in the 8-day IM/IV protocol) is first-line for low-risk GTN with cure rates >95%. Actinomycin D is an alternative single-agent for MTX-resistant low-risk cases. EMA/CO is the standard for high-risk GTN (FIGO score ≥7) or after failure of single-agent therapy. BEP is used for refractory PSTT or ETT. FIGO score 4 = low risk; single-agent MTX is appropriate here.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.