How does your approach to low-risk gestational trophoblastic neoplasia differ for patients whose hCG levels plateau following initial single agent systemic therapy vs those who have a good initial response and then plateau?

For patients with low risk GTN whose hCG values plateau over a two-week interval, concerns arise about chemoresistance. Unfortunately, there is no consensus or clear guideline in terms of determining chemoresistance and when to switch therapy. I don't approach the two clinical scenarios presented here differently in my practice.

One important consideration in this scenario, especially if the patient's levels plateau at a low level (before switching treatment strategy), is the potential for a fal...