Term pregnancy one year after EMA‑CO for FIGO stage III gestational choriocarcinoma with pulmonary metastasis and etoposide hypersensitivity: A case report

Pregnancy after treatment for high-risk gestational trophoblastic neoplasia (GTN) is generally considered feasible with appropriate timing and surveillance. Data are limited for patients who experienced significant chemotherapy hypersensitivity and who declined consolidation chemotherapy.

A 27-year-old with two previous normal vaginal deliveries with prior pre-eclampsia (2020) and postpartum haemorrhage from uterine atony (2022), was diagnosed in 2023 with FIGO stage III: 9 choriocarcinoma with right-lung metastasis. Brain MRI showed no intracranial disease. She commenced EMA-CO chemotherapy. Intravenous etoposide caused Grade 2–3 infusion reactions requiring interruption, premedication, slower re-challenge, and eventual transition to oral etoposide. She declined consolidation chemotherapy and entered surveillance. Approximately one year later, she conceived and had uncomplicated antenatal care. At 37 + 1 weeks, she had a spontaneous vaginal delivery of a healthy female infant. Postpartum issues included intermittent uterine atony responsive to uterotonics, hypokalaemia to 2.5 mmol/L requiring intravenous replacement, and pre-eclampsia (urine protein–creatinine ratio 0.3 g/g) without severe features. Upon discharge plans for early obstetric oncology follow-up and immediate β-hCG reassessment were made.

A favourable term pregnancy outcome can occur after high-risk metastatic GTN treated with EMA-CO despite clinically significant etoposide hypersensitivity and without consolidation therapy. Vigilant surveillance coordinated peripartum care, and early postpartum β-hCG monitoring are essential to exclude disease recurrence.