How we treat relapsed refractory gestational trophoblastic neoplasms-An exciting case series.

Abstract

Objective: Relapsed/refractory gestational trophoblastic neoplasia (RR-GTN) presents a significant therapeutic challenge, with limited options available for patients who fail first-line treatments. In the present study we describe a few unique cases of RR-GTN and various options available for such situations.

Methods: We identified three cases of RR-GTN between January 2021 and December 2022 who failed two or more lines of standard treatment. Clinical characteristics, therapeutic regimens, toxicities, and outcomes were collected from the case records.

Results: We present this case series of three patients with RR-GTN treated with distinct therapeutic approaches: (1) Surgery for localized disease, (2) immunotherapy with pembrolizumab, and (3) tandem autologous stem cell transplantations. We also provide a detailed review of the available literature and guidance on managing RR-GTN.

Conclusion: Intensified chemotherapy regimens, immune checkpoint inhibitors, and autologous stem cell transplantation offer promising avenues for improving outcomes in these high-risk patients. Clinical trials are warranted to establish the optimal sequencing of these therapies in clinical practice, but it may not be possible due to the paucity of such clinical situations.