A patient is diagnosed with high-risk gestational trophoblastic neoplasia (GTN) with a WHO risk score of 13, metastases to brain and liver. According to FIGO 2000 scoring and BGCS/UKCTOCS guidelines, which chemotherapy regimen is the recommended first-line treatment?
- A Single-agent methotrexate with folinic acid rescue
- B BEP (bleomycin, etoposide, cisplatin)
- C EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) ✓
- D TC (paclitaxel + carboplatin)
Correct answer: C. EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine)
Explanation
High-risk GTN (WHO score ≥7) requires multi-agent chemotherapy. EMA-CO (etoposide, methotrexate, actinomycin-D alternating with cyclophosphamide and vincristine) is the standard first-line regimen for high-risk GTN, achieving cure rates of 70–90% even with brain and liver metastases. Single-agent methotrexate is used only for low-risk GTN (WHO score 0–6). BEP is the standard for germ cell tumours; TC is for epithelial ovarian cancer. For patients with brain metastases, CNS-penetrating modifications or cranial irradiation may be added to EMA-CO.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.