Pembrolizumab in gestational trophoblastic neoplasia: Systematic review and meta-analysis with sub-group analysis of potential prognostic factors

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics Pub Date : 2025-01-01 DOI:10.1016/j.clinsp.2025.100583

Marcio Barcellos , Antonio Braga , Matheus Machado Rech , Solange Artimos de Oliveira , Jose Mauro Madi , Sue Yazaki Sun , Jorge de Rezende-Filho , Kevin M. Elias , Neil S. Horowitz , Ross S. Berkowitz

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引用次数: 0

Abstract

Objective

To assess the performance of pembrolizumab for the treatment of Gestational Trophoblastic Neoplasia (GTN).

Methods

The Medical Subject Headings related to immunotherapy/pembrolizumab and GTN were used alone or in combination to retrieve relevant articles. The authors searched in EMBASE, MEDLINE/PubMed, Elsevier's Scopus, and Web of Science until November/2024. The authors included any randomized controlled trials, cohort studies, case series, and case reports focusing on pembrolizumab treatment in GTN. Meta-analysis of proportions was carried out employing a random-effects model. The meta-analysis employed the inverse variance method, with the arcsine link function for the analysis of proportional data. All analyses were performed using Stata 18. For all analyses, a p-value < 0.05 indicated statistical significance. This study was registered on PROSPERO (CRD42023493329).

Results

A total of 550 studies were identified after a literature search among which 15 original studies were included in the systematic review and in the meta-analysis. Pembrolizumab induced complete sustained remission in 71.59% (95% CI 53.27‒84.78%; I² = 0.00%, H² = 1.00, p = 0.90) of cases. The subgroups meta-analysis showed pembrolizumab had similar performance, regardless of age (< 40 vs. ≥ 40-years-old, p = 0.38), GTN histopathology (Placental Site Trophoblastic Tumor [PSTT], Epithelioid Trophoblastic Tumor [ETT]/noninvasive mole/others versus invasive mole/choriocarcinoma, p = 0.48), time from diagnosis to the beginning of immunotherapy (< 4 vs. ≥ 4-years, p = 0.84), pembrolizumab combined with chemotherapy (yes vs. no, p = 0.66).

Conclusions

Pembrolizumab seems an effective treatment for patients with high-risk GTN with chemoresistant or relapsed disease, including cases of PSTT/ETT, notwithstanding patient age, time to initiate immunotherapy and whether or not it was associated with chemotherapy.

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派姆单抗在妊娠滋养细胞瘤中的应用：潜在预后因素亚组分析的系统回顾和荟萃分析

目的评价派姆单抗治疗妊娠滋养细胞瘤（GTN）的疗效。方法采用免疫治疗/派姆单抗和GTN相关的医学主题词单独或联合检索相关文献。作者在EMBASE、MEDLINE/PubMed、爱思唯尔的Scopus和Web of Science中检索到2024年11月。作者纳入了所有随机对照试验、队列研究、病例系列和关注派姆单抗治疗GTN的病例报告。采用随机效应模型对比例进行meta分析。meta分析采用反方差法，用反正弦关联函数对比例数据进行分析。所有分析均使用Stata 18进行。对于所有的分析，p值<；0.05为有统计学意义。本研究已在PROSPERO注册（CRD42023493329）。结果文献检索共纳入550项研究，其中15项原创研究被纳入系统评价和meta分析。派姆单抗诱导的完全持续缓解率为71.59% (95% CI 53.27-84.78%；I2 = 0.00%, H2 = 1.00, p = 0.90)。亚组荟萃分析显示，无论年龄如何，派姆单抗具有相似的疗效(<；40岁vs.≥40岁，p = 0.38)， GTN组织病理学（胎盘部位滋养细胞瘤[PSTT]，上皮样滋养细胞瘤[ETT]/非侵袭性痣/其他与侵袭性痣/绒毛膜癌，p = 0.48），从诊断到开始免疫治疗的时间(<；4年vs≥4年，p = 0.84)，派姆单抗联合化疗（是vs否，p = 0.66）。结论spembrolizumab对于高风险GTN伴化疗耐药或复发的患者（包括PSTT/ETT病例）似乎是一种有效的治疗方法，无论患者年龄、开始免疫治疗的时间以及是否与化疗相关。

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来源期刊

Clinics 医学-医学：内科

CiteScore

4.10

自引率

3.70%

发文量

129

审稿时长

52 days

期刊介绍： CLINICS is an electronic journal that publishes peer-reviewed articles in continuous flow, of interest to clinicians and researchers in the medical sciences. CLINICS complies with the policies of funding agencies which request or require deposition of the published articles that they fund into publicly available databases. CLINICS supports the position of the International Committee of Medical Journal Editors (ICMJE) on trial registration.