First-line chemotherapy for a woman with high-risk gestational trophoblastic neoplasia (WHO score greater than 6) is:
- A Single-agent methotrexate with folinic acid rescue
- B Single-agent dactinomycin
- C EMA-CO regimen ✓
- D Carboplatin and paclitaxel doublet
Correct answer: C. EMA-CO regimen
Explanation
High-risk disease requires multiagent chemotherapy, and EMA-CO, combining etoposide, methotrexate and dactinomycin alternated weekly with cyclophosphamide and vincristine, is the established standard, giving durable remission in about 80 percent of patients while preserving fertility. Single-agent regimens are reserved for low-risk scores of 6 or less and would undertreat high-risk disease. Platinum-taxane combinations are salvage options, not first-line therapy.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.