A 28-year-old woman presents with vaginal bleeding and a markedly elevated β-hCG level of 450,000 mIU/mL. Ultrasound shows a molar pregnancy with no fetal parts. After suction evacuation, she develops persistent gestational trophoblastic neoplasia with pulmonary metastases and an FIGO score of 8. What is the drug of choice for this high-risk molar pregnancy?

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