Term Pregnancy After Complete Response of Placental Site Trophoblastic Tumor to Immunotherapy

Polnaszek, Brock; Mullen, Mary P.; Bligard, Katherine H.; Raghuraman, Nandini; Massad, L. Stewart

doi:10.1097/aog.0000000000004434

Cited by 16 publications

(16 citation statements)

References 17 publications

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“…To date, 8 published case reports (8 pregnant women and 10 newborns) were retrieved. [112][113][114][115][116][117][118][119] Seven of them were diagnosed with metastatic melanoma, and one patient was diagnosed with stage I placental site trophoblastic tumor who received pembrolizumab monotherapy as primary treatment. 112 Among the women diagnosed with melanoma, two received nivolumab monotherapy.…”

Section: Icms In Cancer Therapy and Pregnancy Outcomesmentioning

confidence: 99%

“…[112][113][114][115][116][117][118][119] Seven of them were diagnosed with metastatic melanoma, and one patient was diagnosed with stage I placental site trophoblastic tumor who received pembrolizumab monotherapy as primary treatment. 112 Among the women diagnosed with melanoma, two received nivolumab monotherapy. 113,114 Four received nivolumab plus ipilimumab combination therapy.…”

Section: Icms In Cancer Therapy and Pregnancy Outcomesmentioning

confidence: 99%

“…Here, we have collated the available information to date on the potential impact of ICMs on fertility and pregnancy outcomes. To date, 8 published case reports (8 pregnant women and 10 newborns) were retrieved 112‐119 . Seven of them were diagnosed with metastatic melanoma, and one patient was diagnosed with stage I placental site trophoblastic tumor who received pembrolizumab monotherapy as primary treatment 112 .…”

Section: The Future: Novel Icms and Beyondmentioning

confidence: 99%

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Next generation of immune checkpoint molecules in maternal‐fetal immunity*

Zhao

Muyayalo

Luo

et al. 2022

Immunological Reviews

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Successful pregnancy is a unique situation requires the maternal immune system to recognize and tolerate a semi‐identical fetus and allow normal invasion of trophoblast cells. Although efforts have been made, the deep mechanisms of the maternal‐fetal crosstalk have not yet been fully deciphered. Immune checkpoint molecules (ICMs) are a group of negative modulators of the immune response that avoid immune damage. They have been extensively studied in the fields of oncology and transplantation, while the latest evidence suggests that they are closely associated with pregnancy outcomes via multiple inhibitory mechanisms. Although studies have mostly demonstrated the regulatory role of the well‐known PD‐1, CTLA‐4 at the maternal‐fetal interface, what is unique about the newly discovered multiple ICMs remains a mystery. Here, we review the latest knowledge on ICMs, focusing on the first generation of checkpoints (PD‐1, CTLA‐4) and the next generation (Tim‐3, Tigit, Lag‐3, VISTA) highlighting their immunoregulatory roles in maternal‐fetal tolerance and decidual vascular remodeling, and their involvement in pathological pregnancies. The content covers three aspects: the characteristics they possess, the dynamic expression profile of their expression at the maternal‐fetal interface, and their involvement in pathological pregnancy. In immunotherapy strategies for pregnancy complications, upregulation of immune checkpoints may play a role. Meanwhile, the impact on pregnancy outcomes when using ICMs in clinical cancer treatment during pregnancy is a topic worth exploring. These may serve as a guide for future basic research and clinical applications of maternal‐fetal immunity.

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Section: Icms In Cancer Therapy and Pregnancy Outcomesmentioning

confidence: 99%

Section: Icms In Cancer Therapy and Pregnancy Outcomesmentioning

confidence: 99%

Section: The Future: Novel Icms and Beyondmentioning

confidence: 99%

See 1 more Smart Citation

Next generation of immune checkpoint molecules in maternal‐fetal immunity*

Zhao

Muyayalo

Luo

et al. 2022

Immunological Reviews

View full text Add to dashboard Cite

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“…Regarding the immune-checkpoint inhibitors (ICIs), clinical data from seven women (six being treated for melanoma and one for trophoblastic tumor) who either conceived during therapy or initiated therapy during pregnancy, show that, while first-trimester exposure didn’t result in congenital malformations, second- and third- trimester exposure did lead to intrauterine growth restriction [ 75 , 76 , 77 , 78 , 79 , 80 , 81 ]. Four women gave birth prematurely; one neonate suffered from congenital hypothyroidism, which regressed spontaneously six months later, and another neonate was born without the left hand, a complication which was attributed most probably to mechanical factors and not to the therapy the mother received.…”

Section: Immunotherapy During Pregnancymentioning

confidence: 99%

“…[ 75 , 77 , 78 , 80 ]. Three mothers’ disease progressed, while the other four showed remission [ 76 , 77 , 78 , 79 , 80 , 81 ]. Furthermore, two patients experienced other complications, including diarrhea and liver-related toxicity, mainly jaundice, cholestasis, and elevated liver enzymes.…”

Section: Immunotherapy During Pregnancymentioning

confidence: 99%

Cancer Treatment and Immunotherapy during Pregnancy

et al. 2022

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Background/aim: Immunotherapy has, in recent years, witnessed an expansion in its indications for the treatment of cancer. Coupled with the fact that, nowadays, even more women choose to postpone parenthood, thus increasing their chances of having some kind of malignancy during pregnancy, more and more women are eligible for receiving immunotherapy during this period of their lives. The cases of cancer diagnosed during pregnancy is an ever-increasing trend nowadays. Materials and methods: The oncologists and clinicians treating women often face a range of ethical and therapeutic dilemmas due to the particularity of the patient’s conditions. The primary concern is the protection of the mother, firstly, and then the fetus (through adjustments to the various treatment regimens) if possible. Results and conclusions: Oncological drugs, radiation therapy, surgery, or a combination of all the above methods are selected, depending on the case. In this project, we studied the oncology drugs used for various types of gestational cancer, their appropriateness and timing, as well as their possible effects on the parent and embryo upon their administration. Various studies have shown that the administration of oncological drugs should be postponed until at least after the first trimester of pregnancy.

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Role of immune checkpoint inhibitors combined with chemotherapy in recurrent drug‐resistant gestational trophoblastic neoplasia: Four case reports and literature review

Liu,

Zhu,

Wang

et al. 2024

Cancer Reports

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BackgroundMultiple studies have confirmed that programmed cell death 1 (PD‐1) and programmed cell death ligand 1 (PD‐L1) is widely expressed in gestational trophoblastic neoplasia (GTN) tissues. Therefore, immune checkpoint inhibitors may be an option for the treatment of recurrent and drug‐resistant GTN.CaseFour patients with recurrent or drug‐resistant GTN who were treated with PD‐1/PD‐L1 checkpoint inhibitor agents combined with chemotherapy were reported. The mean age of recurrence was 45.8 years (35–56 years), including three cases of choriocarcinoma (CC) and one case of invasive mole (IM). International Federation of Gynecology and Obstetrics (FIGO) prognosis score: ≤6 (low risk) in one case, 7–12 (high risk) in one case, ≥13 (very high risk) in two cases. There were two cases of lung metastasis and one case of vulvar and inguinal lymph node metastasis. One of the four patients underwent total hysterectomy and one patient underwent resection of lung metastases. All the four patients received comprehensive treatment of immunotherapy combined with chemotherapy after relapse, among which one patient achieved complete response (CR), two patients achieved partial response (PR), and one patient developed progressive disease (PD). Three patients who achieved PR or CR were maintained by single agent immunotherapy after combination therapy, and there was no disease recurrence during follow‐up. One patient with PD also achieved CR after using salvage chemotherapy after recurrence, and there was no disease recurrence during follow‐up. During the treatment, four patients had different degrees of immune‐related adverse reactions, all of which were grade I‐II, and no severe adverse reactions were found.ConclusionImmune checkpoint inhibitors combined with chemotherapy has an impressive therapeutic effect on recurrent or drug‐resistant GTN with mild adverse reactions, which can be used as a treatment option for such patients. However, due to the lack of large sample data support, the specific time and treatment course of its use, long‐term use of adverse reactions and whether it affects fertility function remain to be solved.

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Term Pregnancy After Complete Response of Placental Site Trophoblastic Tumor to Immunotherapy

Cited by 16 publications

References 17 publications

Next generation of immune checkpoint molecules in maternal‐fetal immunity*

Next generation of immune checkpoint molecules in maternal‐fetal immunity*

Cancer Treatment and Immunotherapy during Pregnancy

Role of immune checkpoint inhibitors combined with chemotherapy in recurrent drug‐resistant gestational trophoblastic neoplasia: Four case reports and literature review

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