Would you offer adjuvant therapy for a patient with stage I high risk invasive mole after hysterectomy?

Great question! For this patient’s unique situation, although adjuvant chemotherapy is entirely appropriate, I believe it may not be necessary. The decision to offer adjuvant therapy may be cautiously delayed pending her immediate post-hysterectomy hCG levels. If there is a rapid decline in hCG, observation without adjuvant chemotherapy seems appropriate. With persistent elevation or rise in her hCG level, adjuvant treatment is mandatory. Depending on the hCG level after surgery, single-agent dactinomycin may be appropriate, but if hCG remains significantly elevated, multi-agent chemotherapy should be considered. NCCN Guidelines Version 3.2020 suggest single-agent second-line chemotherapy is appropriate for the patient with a good response ...