Medical: chemotherapy
Indication: 1L treatment
E.g. methotrexate + folinic acid (low risk); etopside, methotrexate, dactinomycin alt with cyclophosphamide and vincristine (high risk)
MOA: destroys proliferating cells; continue until B-hCG normal for 6wk
SEs: GI upset (N+V, diarrhoea), pancytopenia, neutropenic sepsis,
alopecia, peripheral neuropathy, tinnitus, lethargy, anorexia;
low risk regimen: mucositis, pleuritic chest pain;
high risk regimen: secondary cancers, future miscarriage/stillbirth