Immunotherapy for Gestational Trophoblastic Neoplasia: A New Paradigm.

IF 2 4区 医学 Q2 OBSTETRICS & GYNECOLOGY
Gynecologic and Obstetric Investigation Pub Date : 2024-01-01 Epub Date: 2023-09-13 DOI:10.1159/000533972
Inge O Baas, Anneke M Westermann, Benoit You, Pierre-Adrien Bolze, Michael Seckl, Ehsan Ghorani
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引用次数: 0

Abstract

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.

妊娠滋养细胞肿瘤的免疫疗法:一种新的范例。
背景:针对程序性细胞死亡1(PD-1)/配体(PD-L1)的免疫检查点免疫疗法(CPI)已被证明是治疗妊娠滋养细胞肿瘤(GTN)的有效方法。其中包括多药耐药、超高危疾病、上皮样滋养细胞肿瘤/胎盘部位滋养细胞肿瘤亚型,这些亚型本身对化疗具有耐药性,但也有新证据显示可用于低危疾病:我们旨在概述目前支持在高危和低危疾病中使用 CPI 治疗 GTN 的数据,并考虑未来的研究目标和方向,以便在目前的治疗指南中实施 CPI:方法:我们确定并回顾了已发表的关于在 GTN 中使用 CPI 药物的数据:133名患者接受了使用pembrolizumab(23例)、avelumab(22例)、camrelizumab(57例)、toripalimab(15例)或其他抗PD-1药物(16例)治疗GTN的CPI治疗,其中118人患有高危疾病、复发或多重耐药疾病,15人患有低危疾病。共有 85 名患者获得完全缓解,其中 77 人(118 人中)患有高风险疾病,8 人(15 人中)患有低风险疾病。高危组中有1名完全缓解的患者在停止抗PD-1治疗22个月后复发。各项研究的治疗耐受性普遍良好:大多数接受 CPI 治疗的高危患者(77/118)都得到了治愈,这与那些化疗耐药的患者尤其相关,因为他们的治疗选择非常有限。未来研究的重点包括确定这些药物是否在病程早期发挥作用、与化疗联合使用的效用以及对未来生育能力的影响。由于这些药物价格昂贵,治疗的可获得性仍然是一个令人担忧的问题。
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来源期刊
CiteScore
4.20
自引率
4.80%
发文量
44
审稿时长
6-12 weeks
期刊介绍: This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.
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