Advances in current and emerging therapeutics for gestational trophoblast malignancies

ABSTRACT

Introduction: Gestational Trophoblastic Neoplasia (GTN) are a group of rare malignancies arising from the cells of conception. GTN was the first metastatic cancer to be cured with chemotherapy and nearly all of today’s patients can expect to be cured with modern drug treatment. Based on the experience of the GTN unit at Charing Cross Hospital in London, the historical, current and forthcoming management of this biologically unique malignancy will be reviewed.

Areas covered: This review will cover the classification and epidemiology of molar pregnancies, gestational choriocarcinoma and PSTT/ETT. The current approaches to management for low, high and ultra high-risk patients and the recent impact of immunotherapy for chemotherapy resistant disease are discussed.

Expert opinion: GTN form a group of rare but highly curable malignancies. The unique biology of the cancer cells makes them extremely sensitive to chemotherapy and also to immunotherapy and overall cure rates approach 100%. Optimising the organisation of care for this rare group of malignancies increases the cure rates and minimise adverse outcomes. Current immunotherapy research may allow patients to access curative treatment with lower toxicity and reduced long term side effects compared to prolonged treatment with cytotoxic drugs.

KEYWORDS:

• Molar pregnancy
• trophoblastic
• choriocarcinoma
• chemotherapy
• immunotherapy

Article highlights

• Gestational trophoblastic neoplasms are rare but usually curable

• Despite minimal clinical trials there is considerable international consensus on patient management

• Patients with low risk GTN should have a 100% cure rate. They are treated with single agent chemotherapy, with escalation to combination chemotherapy needed in only a small number

• Patients with high risk GTN require multidrug chemotherapy treatment. Which is curative in approximately 90% of patients

• Patients with ultra-high risk and PSTT/ETT can have complex problems and advice from specialist GTN centres can be valuable

• PD1 Immunotherapy can be curative in drug refractory GTN

• The development of national GTN centres can greatly improve patient pathways, research and clinical care and outcomes

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.