Personalized Treatment for Gestational Trophoblastic Neoplasia

Abstract

Gestational trophoblastic neoplasia (GTN) arises from abnormal/neoplastic placental trophoblasts, and comprises a spectrum of premalignant invasive hydatidiform moles to malignant tumors, including gestational choriocarcinoma, and two rare types of GTN such as placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). As GTN is generally highly chemo-sensitive and patients with GTN frequently desire the preservation of fertility, chemotherapy is performed as an initial treatment in the majority of cases. Based on the FIGO risk scoring system, GTN is classified as low-risk GTN and high-risk GTN, and single-agent chemotherapy is recommended for the former and multi-agent chemotherapy is recommended for the latter. On the other hand, surgery is recommended as the initial treatment for PSTT and ETT. Although standard therapy results in a high survival rate, some (approximately 10%) patients with advanced/metastatic high-risk GTN or PSTT/ETT exhibit chemo-resistance, and the prognosis of these patients is poor. Recently, much attention has been paid to the use of immune checkpoint inhibitors, such as anti-PD-1 or anti-PD-L1 antibodies, as a single therapy or in combination with antiangiogenic therapy, with high clinical efficacy. Although further accumulation of evidence from clinical trials and investigation of biomarkers for good responders to immunotherapy is needed, individualized treatment using immune checkpoint inhibitors may be effective for chemo-resistant/refractory GTN.