{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T20:15:11Z","timestamp":1789848911796,"version":"4.0.1"},"reference-count":19,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2000,2,14]]},"abstract":"<jats:p> PURPOSE: To evaluate the results of etoposide, cisplatin\/etoposide, methotrexate, and actinomycin D (EP\/EMA) chemotherapy in patients with gestational trophoblastic tumors (GTTs), who have relapsed after or who have become refractory to EMA\/cyclophosphamide and vincristine (CO) chemotherapy, and in patients presenting with metastatic placental site trophoblastic tumors (PSTTs). <\/jats:p><jats:p> PATIENTS AND METHODS: We have treated a total of 34 patients with GTT and eight patients with metastatic PSTT with the EP\/EMA chemotherapy schedule. <\/jats:p><jats:p> RESULTS: Twenty-two patients received EP\/EMA because of apparent drug resistance to EMA\/CO, and because the human chorionic gonadotropin (hCG) was near normal, they were not assessable for response. Twenty-one of these patients (95%) are alive and in remission. In the group where the hCG was high enough to confirm a response (greater than one log fall in hCG) to EP\/EMA, all 12 patients responded and nine of these patients (75%) are alive and in remission. We have treated three patients with PSTT where the interval from antecedent pregnancy was less than 2 years, and all patients (100%) are alive and in remission. We have treated five patients where the interval from antecedent pregnancy was greater than 2 years and one fifth (20%) remain in remission. The survival for patients with GTT is 30 (88%) out of 34 patients and four (50%) out of eight patients for PSTT, giving an overall survival for these two cohorts of 34 (81%) out of 42 patients. The toxicity of this schedule is significant, with grade 3 or 4 toxicity (National Cancer Institute common toxicity criteria) recorded in hemoglobin (21%), WBC (68%), and platelets (40%). The role of surgery in this group of patients is important and contributed to sustained remission in five patients (23%) and possibly helped an additional seven patients (32%). <\/jats:p><jats:p> CONCLUSION: EP\/EMA is an effective but moderately toxic regimen for patients with high-risk GTT who become refractory to or relapse from EMA\/CO chemotherapy. Also, EP\/EMA clearly has activity in patients with metastatic PSTT. <\/jats:p>","DOI":"10.1200\/jco.2000.18.4.854","type":"journal-article","created":{"date-parts":[[2017,2,24]],"date-time":"2017-02-24T07:02:08Z","timestamp":1487919728000},"page":"854-854","source":"Crossref","is-referenced-by-count":208,"title":["Etoposide and Cisplatin\/Etoposide, Methotrexate, and Actinomycin D (EMA) Chemotherapy for Patients With High-Risk Gestational Trophoblastic Tumors Refractory to EMA\/Cyclophosphamide and Vincristine Chemotherapy and Patients Presenting With Metastatic Placental Site Trophoblastic Tumors"],"prefix":"10.1200","volume":"18","author":[{"given":"E.S.","family":"Newlands","sequence":"first","affiliation":[{"name":"From the Department of Medical OncologyCharing Cross Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.J.","family":"Mulholland","sequence":"additional","affiliation":[{"name":"From the Department of Medical OncologyCharing Cross Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Holden","sequence":"additional","affiliation":[{"name":"From the Department of Medical OncologyCharing Cross Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.J.","family":"Seckl","sequence":"additional","affiliation":[{"name":"From the Department of Medical OncologyCharing Cross Hospital, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.J. 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