An extrauterine extensively metastatic epithelioid trophoblastic tumor responsive to pembrolizumab

Bell, Sarah; Uppal, Shitanshu; Sakala, Michelle D.; Sciallis, Andrew P.; Rolston, Aimee

doi:10.1016/j.gore.2021.100819

Cited by 17 publications

(20 citation statements)

References 20 publications

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“…However, current treatments often negatively impact the health, fertility, and even the lifespan of women. Immunotherapy typically involves vascular endothelial growth factor, PD-1/programmed death ligand 1, tyrosine kinase, or other targeting monoclonal antibodies despite some patients not showing improvement and exhibiting serious side effects (3)(4)(5)(6)(7). Therefore, it is necessary to look for alternative biocompatible materials for the diagnosis, evaluation, and treatment of gynecological cancers.…”

Section: Introductionmentioning

confidence: 99%

Cytocompatibility of pH-sensitive, chitosan-coated Fe3O4 nanoparticles in gynecological cells

Zhang

Wang²,

He³

et al. 2022

Front. Med.

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Nanoparticles that contact human cells without damaging basic human tissues are becoming more widely used in medicine. Efficient delivery to the intracellular target cell or compartment through the cell membrane must be achieved with minimal cytotoxicity to healthy cells. Fe3O4 nanoparticles have been widely used in biomedical research for their magnetic, non-toxic, and biocompatible properties. However, the effects of Fe3O4 nanoparticles coated with chitosan (CS) on gynecological cells are unclear. In this study, the Fe3O4 nanoparticles were coated with CS to enhance their cytocompatibility and dispersion in water. These CS-Fe3O4 nanoparticles were taken up by gynecological cells and did not affect cell viability in vitro. They have greater cytocompatibility in acidic environments than normal Fe3O4 nanoparticles and have the potential for drug delivery into gynecological cells.

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Section: Introductionmentioning

confidence: 99%

Cytocompatibility of pH-sensitive, chitosan-coated Fe3O4 nanoparticles in gynecological cells

Zhang

Wang²,

He³

et al. 2022

Front. Med.

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“…After PD-L1 testing showed the tumor had more than 5% PD-L1 positivity, Pembrolizumab therapy was initiated. After 28 cycles, imaging demonstrated a partial response to treatment [ 51 ].…”

Section: Resultsmentioning

confidence: 99%

Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN)

Mangili

Sabetta

Cioffi

et al. 2022

Cancers

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Background: Gestational trophoblastic disease includes a rare group of benign and malignant tumors derived from abnormal trophoblastic proliferation. Malignant forms are called gestational trophoblastic neoplasia (GTN) and include invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Standard treatment of GTN is chemotherapy. The regimen of choice mainly depends on the FIGO prognostic score. Low-risk and high-risk GTN is treated with single-agent or multiagent chemotherapy, respectively. In the case of chemoresistance, immunotherapy may represent a new therapeutic strategy. Methods: Literature obtained from searches on PubMed concerning GTN and immunotherapy was reviewed. Results: Programmed cell death 1 (PD-1) and its ligands (PD-L1/2) are expressed in GTN. Published data on PD-1/PD-L1 inhibitors alone in GTN were available for 51 patients. Pembrolizumab is an anti-PD-1 inhibitor used in chemoresistant forms of GTN. In the TROPHIMMUN trial, Avelumab, a monoclonal antibody inhibiting PD-L1, showed promising results only in patients with GTN resistant to monochemotherapy. Conversely, in patients with resistance to multiagent chemotherapy, treatment with Avelumab was discontinued due to severe toxicity and disease progression. The association of Camrelizumab and Apatinib could represent a different treatment for forms of GTN refractory to polychemotherapy or for relapses. Conclusions: Anti-PD-1 or anti-PD-L1 might represent an important new treatment strategy for the management of chemoresistant/refractory GTN.

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“…Two patients (case 10 and Bell etc. [ 17 ]) were finally treated with PD-1 antibody which could control the disease well. The refractory and recurrent cases achieved CR with chemotherapy combined with immune checkpoint inhibitors (pembrolizumab) based on the high expression of PD-1/PD-L1 [ 6 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Gestational trophoblastic neoplasia with extrauterine metastasis but lacked uterine primary lesions: a single center experience and literature review

Wang

Lü

et al. 2022

BMC Cancer

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Background To investigate the clinicopathological characteristics, diagnoses, treatments, and outcomes of a special type of gestational trophoblastic neoplasia (GTN) which only has extrauterine metastases without uterine primary lesions. Methods The medical records and pathological sections of the patients who were pathologically diagnosed as GTN, only had extrauterine metastatic lesions but lacked uterine primary lesions, in Women’s Hospital of Zhejiang University School of Medicine from February 2014 to March 2021 were collected and reviewed. Results Thirteen patients with pathologically confirmed GTN presenting with extrauterine metastases from a missing primary site were included in the past 7 years. The median age was 31.2 years old. 76.9% of patients had a non-hydatidiform pregnancy last time. The intervals between the antecedent pregnancy were > 12 months in 61.5% of patients. Pretreatment serum human chorionic gonadotropin(hCG) levels ranged from 118.7 to 807,270 IU/L. Six patients were misdiagnosed as ectopic pregnancy at initial diagnosis, and 4 as primary tumors at metastatic sites. All of them were diagnosed definitely by surgical pathology including 8 choriocarcinomas (CC), 4 epithelioid trophoblastic tumors (ETTs), and 1 mixed GTN (CC mixed with ETT). All patients achieved complete remission (CR) after treatments. Three patients relapsed; no patient died by the end of follow-up. Conclusion GTN presenting with extrauterine metastases from a missing primary site is easily misdiagnosed. Detection of serum hCG in these patients can reduce misdiagnosis. Chemotherapy combined with individualized surgery should be considered for these special GTN patients. Immune checkpoint inhibitors might be potential remedial measures for refractory and recurrent patients.

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An extrauterine extensively metastatic epithelioid trophoblastic tumor responsive to pembrolizumab

Cited by 17 publications

References 20 publications

Cytocompatibility of pH-sensitive, chitosan-coated Fe3O4 nanoparticles in gynecological cells

Cytocompatibility of pH-sensitive, chitosan-coated Fe3O4 nanoparticles in gynecological cells

Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN)

Gestational trophoblastic neoplasia with extrauterine metastasis but lacked uterine primary lesions: a single center experience and literature review

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