Comparing cisplatin-based combination chemotherapy with EMA/CO chemotherapy for the treatment of high risk gestational trophoblastic neoplasia

Abstract Background Cisplatin-based chemotherapy (etoposide 100 mg/m 2 days 1–5, methotrexate 300 mg/m 2 day 1, cyclophosphamide 600 mg/m 2 day 1, actinomycin D 0.6 mg/m 2 day 2 and cisplatin 60 mg/m 2 day 4, EMACP) was compared to EMA/CO (etoposide 100 mg/m 2 days 1–2, methotrexate 300 mg/m 2 day 1 and actinomycin D 0.5 mg i.v. bolus day 1 and 0.5 mg/m 2 day 2, alternating with cyclophosphamide 600 mg/m 2 day 8 and vincristine 1 mg/m 2 day 8) for the treatment of high-risk gestational trophoblastic neoplasia (GTN). Patients and methods In the Netherlands, 83 patients were treated with EMACP and 103 patients with EMA/CO. Outcome measures were remission rate, median number of courses to achieve normal human chorionic gonadotrophin (hCG) concentrations, toxicity, recurrent disease rate and disease specific survival. Results Remission rates were similar (EMACP 91.6%, EMA/CO 85.4%). The median number of courses of EMA/CO to reach hCG normalisation for single-agent resistant disease and primary high-risk disease was three and five courses, respectively, compared to 1.5 ( p  = 0.001) and three ( p Conclusion EMACP combination chemotherapy is an effective treatment for high-risk GTN, with a remission rate comparable to EMA/CO. However, the difference in duration of treatment is only slightly shorter with EMACP. Cisplatin-based chemotherapy in the form of EMACP in this study was not proven more effective than EMA/CO.