Treatments and outcomes in high‐risk gestational trophoblastic neoplasia: A systematic review and meta‐analysis

Abstract

Background: High-risk gestational trophoblastic neoplasia (GTN) is rare and treated with diverse approaches. Limited published institutional data has yet to be systematically reviewed. Objectives: To compile global high-risk GTN (prognostic score ≥7) cohorts to summarise treatments and outcomes by disease characteristics and primary chemotherapy. Search Strategy: MEDLINE, Embase, Scopus, ClinicalTrials.gov and Cochrane were searched through March 2021. Selection Criteria: Full-text manuscripts reporting mortality among ≥10 high-risk GTN patients. Data Collection and Analysis: Binomial proportions were summed, and randomeffects meta-analyses performed. Main Results: From 1137 records, we included 35 studies, representing 20 countries. Among 2276 unique high-risk GTN patients, 99.7% received chemotherapy, 35.8% surgery and 4.9% radiation. Mortality was 10.9% (243/2236; meta-analysis: 10%, 95% confidence interval [CI] 7-12%) and likelihood of complete response to primary chemotherapy was 79.7% (1506/1890; meta-analysis: 78%, 95% CI: 74-83%). Across 24 reporting studies, modern preferred chemotherapy (EMA/CO or EMA/EP) was associated with lower mortality (overall: 8.8 versus 9.5%; comparative meta-analysis: 8.1 versus 12.4%, OR 0.42, 95% CI: 0.20-0.90%, 14 studies) and higher likelihood of complete response (overall: 76.6 versus 72.8%; comparative meta-analysis: 75.9 versus 60.7%, OR 2.98, 95% CI: 1.06-8.35%, 14 studies), though studies focused on non-preferred regimens reported comparable outcomes. Mortality was increased for ultra-high-risk disease (30 versus 7.5% high-risk; meta-analysis OR 7.44, 95% CI: 4.29-12.9%) and disease following term delivery (20.8 versus 7.3% following molar pregnancy; meta-analysis OR 2.64, 95% CI: 1.10-6.31%). Relapse rate estimates ranged from 3 to 6%. Conclusions: High-risk GTN is responsive to several chemotherapy regimens, with EMA/CO or EMA/EP associated with improved outcomes. Mortality is increased in patients with ultra-high-risk, relapsed and post-term pregnancy disease.

Intracardiac metastasis of gestational choriocarcinoma: a case report and literature review

“…Thought the current case did not received immunotherapy, and there is no report of patients with GTN and intracardiac metastasis who experience PD-1 and PD-L1 inhibitor, immunotherapy in GTN has made great progress in recent years, with successful therapeutic outcomes in several clinical studies [ 26 – 29 ]. Previous researches have revealed that programmed cell death ligand (PD-L1) is highly expressed in GTN tumor tissue [ 30 , 31 ], and other immune targets TIM-3, LAG-3, and GAL-9 are also widely expressed in GTN [ 32 ].…”

Placental-site trophoblastic tumor with bone metastasis: A diagnostic and therapeutic challenge

“…Imaging studies (ultrasound, CT, and MRI) are useful to locate genital lesions and metastases as in other pathologies. Although ultrasound findings are not considered as a diagnostic criteria for PSTT according to FIGO, it is postulated that solid lesions with low blood flow (doppler) along with low levels of elevated serum B-hCG would be sufficient to diagnose PSTT ( Albright et al, 2023 , Yan et al, 2015 , Santaballa et al, 2018 ). In our case, we were surprised by the detection by CT of the tumor, as it was not observed during prior ultrasounds, but we have found some other reports in which the lesions were not visualized on ultrasound ( Gadducci et al, 2019 ).…”

“…The most widely used regimen is EMA-CO (etoposide-methotrexate-actinomycin D-cyclophosphamide-vincristine), but approximately 20 % of these patients suffer recurrences. For those women with high or very high-risk based on FIGO criteria, or with recurrence after EMA-CO (20 %), other regimens include PE/EMA (etoposide-cisplatin/etoposide-methotrexate-actinomycin D) or TE/TP (taxol-etoposide/taxol-cisplatin) ( Santaballa et al, 2018 , National Cancer Institute, 2022 , Clark et al, 2021 , Albright et al, 2023 ).…”