Primary treatment of metastatic high-risk gestational trophoblastic neoplasia with EMA-CO chemotherapy

John R. Lurain*, Diljeet K. Singh, Julian C. Schink

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


OBJECTIVE: To evaluate the efficacy of etoposide, methotrexate, actinomycin D, cydophosphamide and vincristine (EMA-CO) in the primary treatment of metastatic high-risk gestational trophoblastic neoplasia. STUDY DESIGN: Thirty women with metastatic high-risk gestational trophoblastic neoplasia were treated primarily with EMA-CO between 1986 and 2005. Patients who had incomplete responses or developed resistance to EMA-CO were treated with drug combination employing etoposide and a platinum agent with or without bleomycin or ifosfamide. Adjuvant surgery and radiotherapy were used in selected patients. Survival, clinical response and factors affecting treatment success were analyzed retrospectively. RESULTS: The overall survival rate was 93.3% (28 of 30). Of the 30 patients treated with EMA-CO, 20 (66.7%) had a lasting clinical response, 8 (26.7%) developed resistance but were subsequently placed in remission with platinum-based chemotherapy, and 2 (6.7%) died of widespread metastatic disease. Clinical complete response to EMA-CO was significantly influenced by human chorionic gonadotropin level (<100,000 mIU/ml, 82%, vs. >100,000 mIU/ml, 4.6%), metastatic site (lung and pelvis, 75%, vs. other, 33%) and International Federation of Gynecology and Obstetrics (FIGO) risk factor score (<7, 92% vs. >7, 50%). Surgical procedures were performed on 12 patients, and 4 patients received brain irradiation. Eight (80%) of 10 patients who received secondary platinum-based chemotherapy with or without surgery were cured. The 2 patients who died had stage IV disease (brain and/or liver metastases) with FIGO scores of 13 and 14. CONCLUSION: Over 93% of 30 patients with metastatic high-risk gestational trophoblastic neoplasia treated initially with the EMA-CO protocol, often in conjunction with brain irradiation, surgical resection of sites of persistent tumor and salvage platinum-based chemotherapy, were cured.

Original languageEnglish (US)
Pages (from-to)767-772
Number of pages6
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Issue number10
StatePublished - Oct 1 2006


  • EMA-CO protocol
  • Gestational trophoblastic neoplasms
  • Metastasis

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology


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