A 30-year-old woman had a molar pregnancy evacuated 6 months ago. Serial β-hCG showed plateauing at 850 IU/L for 3 consecutive weeks. CT chest shows two pulmonary nodules each less than 2 cm. She received one prior course of single-agent methotrexate. WHO/FIGO prognostic scoring: age 30 (0), antecedent molar pregnancy (0), interval 6 months (1), pre-treatment hCG 850 IU/L (0), largest tumour less than 3 cm (0), lung metastases — 2 sites (1), prior single-agent chemotherapy (2). Total score = 4. Which treatment is indicated?
- A Single-agent chemotherapy (switch to actinomycin D — low-risk regimen) ✓
- B EMA-CO (Etoposide, Methotrexate, Actinomycin D / Cyclophosphamide, Vincristine)
- C Hysterectomy followed by adjuvant chemotherapy
- D Observation only as β-hCG is less than 1000 IU/L
Correct answer: A. Single-agent chemotherapy (switch to actinomycin D — low-risk regimen)
Explanation
WHO score of 4 classifies this as low-risk GTN (score 0–6). This patient has methotrexate-resistant low-risk GTN; the correct approach is to switch to a different single-agent (actinomycin D), not escalate to multi-agent EMA-CO which is reserved for high-risk disease (score 7 or above). Hysterectomy is not first-line. Observation is not appropriate for a plateauing hCG.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.