A 31-year-old woman has high-risk gestational trophoblastic neoplasia with a WHO prognostic score of 11 and multiple lung metastases. She has received no prior chemotherapy. What is the recommended first-line chemotherapy regimen?
- A EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) ✓
- B Actinomycin D weekly intravenously
- C Single-agent methotrexate with folinic acid rescue
- D Carboplatin and paclitaxel every three weeks
Correct answer: A. EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine)
Explanation
WHO score of 7 or more defines high-risk disease, which requires multiagent chemotherapy; EMA-CO is the standard first-line regimen with cure rates around 85 percent while preserving fertility in most women. Single-agent methotrexate or actinomycin D is reserved for low-risk disease (score 6 or less) and fails in high-risk patients. Platinum-taxane combinations are second-line salvage therapy, typically EP-EMA after EMA-CO failure, not initial treatment for de novo high-risk disease.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.