Treatment of gestational trophoblastic disease in the 2020s.

Abstract

PURPOSE OF REVIEW:

This review demonstrates the evidence for new systemic anticancer treatments and how they integrate within conventional management for gestational trophoblastic neoplasia (GTN). We present the evidence on atypical placental site nodules, and how they incorporate within the GTN spectrum, as well as updates regarding GTN staging and follow-up.

RECENT FINDINGS:

First-line treatment for GTN still lies in conventional chemotherapy, although the introduction of anti-PD1/PD-L1 immune checkpoint inhibitors has shown significant promise in management of relapsed disease, with responses reported in multiple relapsed choriocarcinomas as well as epithelioid trophoblastic tumours and placental site trophoblastic tumours (ETT/PSTT). Following completion of treatment, ETT/PSTT still require life-long surveillance but for other GTN, no recurrences have been detected after 7 years.

SUMMARY:

Checkpoint inhibitors are likely to play an increasing role in the future management of GTN management. Further refinement of prognostic factors to identify those most at risk of GTN recurrence is warranted so that surveillance can be focussed on those most at risk, whilst minimizing unnecessary intervention for those at lower risk.

• Authors: James J Clark, Susanna Slater, Michael J Seckl
• Journal: Current opinion in obstetrics & gynecology (Curr Opin Obstet Gynecol) Vol. 33 Issue 1 Pg. 7-12 (02 01 2021) ISSN: 1473-656X [Electronic] England
• PMID: 33337613 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Immune Checkpoint Inhibitors
• PDCD1 protein, human
• Programmed Cell Death 1 Receptor

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Female
• Gestational Trophoblastic Disease (diagnosis, drug therapy)
• Humans
• Immune Checkpoint Inhibitors (therapeutic use)
• Neoplasm Recurrence, Local
• Placenta (pathology)
• Pregnancy
• Programmed Cell Death 1 Receptor
• Trophoblastic Tumor, Placental Site (drug therapy, pathology)
• Uterine Neoplasms (drug therapy, pathology)