# EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients

Source: https://onco.cc/key-papers/paper-bower-ema-co-high-risk-gtn-charing-cross-jco-1997/  
OnCo record `paper-bower-ema-co-high-risk-gtn-charing-cross-jco-1997` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The Charing Cross series that established EMA/CO, an alternating weekly combination of five drugs, as the standard treatment for high-risk gestational trophoblastic disease, curing more than eight in ten women.

## Summary

Retrospective analysis of 272 women with high-risk gestational trophoblastic tumours treated at Charing Cross Hospital with EMA/CO (etoposide, methotrexate and dactinomycin alternating weekly with cyclophosphamide and vincristine) between 1979 and 1995.

Five-year survival was about 86 percent, with complete remission in most and salvage of many who relapsed or were resistant using platinum-containing regimens and surgery; early deaths from disease and secondary leukaemia after etoposide were noted.

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: Journal of Clinical Oncology
- Year: 1997
- DOI: 10.1200/JCO.1997.15.7.2636
- Authors: Bower M, Newlands ES, Holden L, et al.
- Findings: Five-year survival about 86 percent for high-risk GTN treated with EMA/CO.; Relapse or resistance in a minority, most salvaged with platinum-based regimens and surgery.
- What it means: EMA/CO remains the first-line regimen for high-risk GTN worldwide; later Charing Cross work added low-dose induction etoposide-cisplatin for women with very high scores.
- Caveats: Retrospective single-centre series; no randomised trial has compared high-risk regimens.; Etoposide carries a small risk of secondary leukaemia.

## Sources

- J Clin Oncol 1997: https://doi.org/10.1200/JCO.1997.15.7.2636
- PubMed: https://pubmed.ncbi.nlm.nih.gov/9215835/

## Connected records

- cancers: [High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk)](https://onco.cc/cancers/high-risk-gtn/)
- drugs: [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Dactinomycin (actinomycin D)](https://onco.cc/drugs/dactinomycin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Vincristine](https://onco.cc/drugs/vincristine/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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