A 35-year-old woman is diagnosed with choriocarcinoma following a term delivery 6 months ago. She has lung metastases and a WHO prognostic score of 9. According to FIGO 2000 staging and WHO scoring, what is the recommended chemotherapy regimen?

• A Single-agent methotrexate
• B Single-agent actinomycin-D
• C BEP (bleomycin, etoposide, cisplatin)
• D EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) ✓

Explanation

A WHO score of ≥7 defines high-risk gestational trophoblastic neoplasia. High-risk GTN requires multi-agent chemotherapy, and EMA-CO is the most widely used first-line regimen. Single-agent methotrexate or actinomycin-C is reserved for low-risk GTN (WHO score ≤6). BEP is used for ovarian germ cell tumors, not GTN. The patient's score of 9, antecedent term pregnancy (2 points), and lung metastases all mandate aggressive multi-agent therapy.

Reference: FIGO Committee on Gynecologic Oncology: FIGO staging for gestational trophoblastic neoplasia, 2000 (Int J Gynaecol Obstet 2002) ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.