etoposide + methotrexate + actinomycin d + cisplatin

This is a combination chemotherapy regimen consisting of four cytotoxic agents—etoposide, methotrexate, actinomycin D (also known as dactinomycin), and cisplatin. It is primarily used for the treatment of high-risk gestational trophoblastic tumors (GTT), including choriocarcinoma and metastatic placental site trophoblastic tumors (PSTT), particularly in patients who are refractory to or relapse after first-line regimens such as EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine). The mechanism of action involves multiple pathways: - Etoposide inhibits topoisomerase II, leading to DNA strand breaks. - Methotrexate inhibits dihydrofolate reductase, blocking DNA synthesis. - Actinomycin D intercalates into DNA and inhibits RNA synthesis. - Cisplatin forms DNA crosslinks that prevent replication and transcription. The regimen is effective but associated with significant hematologic toxicity. It is administered in cycles with specific dosing schedules for each agent[1][2][3].

Other names

EP-EMAEP/EMA