EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients
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.
Overview
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.
- 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.
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.
- Retrospective single-centre series; no randomised trial has compared high-risk regimens.
- Etoposide carries a small risk of secondary leukaemia.
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