Depending on the extent of disease and the serum level of hCG, patients with stage I, II, or III disease are treated by evacuation of their pregnancy or with chemotherapy. The desire to remain fertile is a factor in the selection of treatment for patients with stage I disease. For patients with stage II or III disease, treatment options include single-agent and combination chemotherapy. Patients with stage IV disease require intensive combination chemotherapy along with selective use of tumor-reductive surgery and radiation therapy. Nearly 75 percent of stage IV patients undergo remission.
More recent regimens make use of vinblastine, bleomycin, and cisplatin, with excellent results.
Evidence suggests that etoposide is also active against gestational trophoblastic tumors. Etoposide has been reported to cause damage to chromosome 11q23, leading to secondary myeloid leukemia, in patients who have been treated for testicular or small cell lung cancers. Therefore, the value of including etoposide in trophoblastic gestational tumor regimens should be reconsidered. Many patients, usually those with stage I or II disease, can resume normal reproductive function after treatment. However, there is an increased incidence of hydatidiform moles or gestational trophoblastic neoplasms after subsequent pregnancies.