[Preliminary study of PD-1 inhibitor in the treatment of drug-resistant recurrent gestational trophoblastic neoplasia]

Immunotherapy for Gestational Trophoblastic Neoplasia: A New Paradigm

BACKGROUND

Immune checkpoint immunotherapy (CPI) targeting programmed cell death 1 (PD-1)/ligand (PD-L1) has been shown to be an effective treatment for gestational trophoblastic neoplasia (GTN). This includes those with multidrug resistance, ultra-high-risk disease, and epithelioid trophoblastic tumour/placental site trophoblastic tumour subtypes that are inherently chemotherapy resistant, but there is also emerging evidence in low-risk disease.

OBJECTIVES

We set out to generate an overview of the current data supporting the use of CPI for GTN in both high-risk and low-risk disease and to consider future research goals and directions in order to implement CPI in current treatment guidelines.

METHODS

We identified and reviewed the published data on the use of CPI agents in GTN.

OUTCOME

133 patients were identified who had been treated with CPI for GTN with pembrolizumab (23), avelumab (22), camrelizumab (57), toripalimab (15), or other anti-PD-1 agents (16), of whom 118 had high-risk diseases, relapse or multi-drug resistant disease, and 15 low-risk diseases. Overall 85 patients achieved complete remission, 77 (of 118) with high-risk disease, and 8 (of 15) with low-risk disease. 1 patient with complete remission in the high-risk group developed a relapse 22 months after anti-PD-1 treatment had been stopped. Treatment was generally well tolerated across studies.

CONCLUSIONS AND OUTLOOK

The majority of high-risk patients (77/118) treated with CPI are cured and this is particularly relevant amongst those with chemotherapy resistant disease who otherwise have very limited treatment options. Priorities for future research include determining whether these agents have a role earlier in the disease course, the utility of combination with chemotherapy, and effects on future fertility. Treatment availability remains a concern due to the high price of these agents.

Effectiveness and Safety of Toripalimab Combination Therapies for Patients With Chemo-Resistant Choriocarcinoma

Toripalimab as a novel PD-1 inhibitor has presented its promising efficacy in patients who developed chemo-refractory carcinomas, whereas no study has ever investigated the effectiveness of toripalimab in chemo-resistant choriocarcinoma. Here we reported the effectiveness and safety data of 4 patients with chemo-resistant choriocarcinoma who underwent PD-1 antibody therapy by toripalimab and individualized chemotherapies. From January 2019 to August 2020, 4 patients with choriocarcinoma were admitted in Shengjing Hospital of China Medical University. The patients’ age ranged from 29 to 52 years with a median of 36 years. All the patients achieved CR after the combined therapy of toripalimab with individualized chemotherapies according to the decreased serum β-hcg level. Two of the four patients were observed with treatment-related adverse events (AEs), including one grade I skin rash and one grade I pruritus. Our cases showed that toripalimab combined with chemotherapy presented a tolerable safety profile and promising effectiveness in patients with chemo-resistant choriocarcinoma, indicating its potential as salvage therapy for this subset of patients.

Real-world data of 14 cases of brain metastases from gestational trophoblastic neoplasia and a literature review

OBJECTIVE

The aim of this study was to investigate the diagnosis, treatment, and prognosis of patients with brain metastases from gestational trophoblastic neoplasia (GTN) in the real world.

METHODS

Analyzing the clinicopathological characteristics, treatment process, and prognosis of 14 GTN patients with brain metastases admitted to the West China Second University Hospital between January 2006 and December 2020.

RESULTS

The median FIGO prognostic score was 15 points (range 11-21 points), with 12 cases having 13 points or more (extremely high risk). All patients received combination chemotherapy. The first-line regimen included 5-Fluorouracil, dactinomycin, and intrathecal methotrexate (5-FU + KSM + intrathecal MTX), and etoposide + methotrexate + actinomycin D/cyclophosphamide and vincristine (EMA-CO). Two patients died during the early period after diagnosis of brain metastases. A further patient with GTN Stage III failed to achieve a negative serum β human chorionic gonadotropin (hCG) after receiving chemotherapy in another hospital. Ten months after self-discontinuation of treatment, the disease progressed and she was admitted to our hospital with suspected liver and brain metastases, after which she abandoned treatment and was lost to follow-up. Among the remaining 11 patients, one relapsed once and two relapsed three times. Aside from the two patients who died and the one who was lost to follow-up, the remaining 11 patients had a median follow-up time of 89 months (range 35-148 months) and all achieved complete remission.

CONCLUSION

The overall survival rate of the patients in the present study was 78.57% through combination chemotherapy, symptomatic treatment, and co-treatment with brain radiotherapy for some patients. Enhancing the understanding of this disease and standardizing treatment are key to improving the overall survival rate of GTN patients with brain metastases.

Ultra-high-risk choriocarcinoma with atraumatic splenic rupture: a rare case report

Choriocarcinoma is a malignant tumor associated with early vascular invasion and a high mortality. Ultra-high-risk choriocarcinoma, which was proposed in the International Federation of Gynecology and Obstetrics cancer report of 2018, has a higher risk of treatment failure and a worse prognosis than choriocarcinoma. We report a rare case of a 39-year-old female patient with ultra-high-risk choriocarcinoma (stage IV:20) with hemorrhage secondary to atraumatic splenic rupture as the initial sign. A satisfactory outcome was achieved through comprehensive treatment with surgery, chemotherapy, immunotherapy, and targeted therapy.

Long-term survival in multiresistant metastatic choriocarcinoma after pembrolizumab treatment: A case report

•Checkpoint inhibitor therapy affecting PD-L1 as treatment for advanced solid tumors.•Success in trial pembrolizumab therapy in multiresistant metastatic choriocarcinoma.•Long-term remission after pembrolizumab therapy in multiresistant choriocarcinoma.•Only six reported cases, one with comparable follow-up and outcome.