Treatment of gestational trophoblastic disease in the 2020s.
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Female
Gestational Trophoblastic Disease
/ diagnosis
Humans
Immune Checkpoint Inhibitors
/ therapeutic use
Neoplasm Recurrence, Local
Placenta
/ pathology
Pregnancy
Programmed Cell Death 1 Receptor
Trophoblastic Tumor, Placental Site
/ drug therapy
Uterine Neoplasms
/ drug therapy
Journal
Current opinion in obstetrics & gynecology
ISSN: 1473-656X
Titre abrégé: Curr Opin Obstet Gynecol
Pays: England
ID NLM: 9007264
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
pubmed:
19
12
2020
medline:
23
9
2021
entrez:
18
12
2020
Statut:
ppublish
Résumé
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. 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. 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.
Identifiants
pubmed: 33337613
doi: 10.1097/GCO.0000000000000674
pii: 00001703-202102000-00003
pmc: PMC7116872
mid: EMS117041
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
PDCD1 protein, human
0
Programmed Cell Death 1 Receptor
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
7-12Subventions
Organisme : Cancer Research UK
ID : A15589
Pays : United Kingdom
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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