{"entity":{"id":"paper-bower-ema-co-high-risk-gtn-charing-cross-jco-1997","kind":"paper","name":"EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients","aka":[],"tldr":"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.\n\nFive-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.","asOf":"2026-09-18","links":[{"label":"J Clin Oncol 1997","url":"https://doi.org/10.1200/JCO.1997.15.7.2636"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/9215835/"}],"tags":[],"related":[],"cancers":["high-risk-gtn"],"sections":[],"technologies":[],"targets":[],"drugs":["etoposide","methotrexate","dactinomycin","cyclophosphamide","vincristine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":1997,"doi":"10.1200/JCO.1997.15.7.2636","pmid":"9215835","authors":"Bower M, Newlands ES, Holden L, et al.","paperType":"observational","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."],"whatItMeans":"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."],"changedPractice":true,"participants":272},"route":"/key-papers/paper-bower-ema-co-high-risk-gtn-charing-cross-jco-1997/","neighbours":{"cancer":[{"id":"high-risk-gtn","kind":"cancer","name":"High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk)","route":"/cancers/high-risk-gtn/"}],"drug":[{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"dactinomycin","kind":"drug","name":"Dactinomycin (actinomycin D)","route":"/drugs/dactinomycin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}