A novel alternative to cytotoxic chemotherapy for gestational trophoblastic disease.

Abstract

Gestational trophoblastic neoplasia refers to malignancies derived from placental trophoblasts. The principal treatment is chemotherapy. The WHO and International Federation of Obstetrics and Gynecology (FIGO) prognostic scoring system is used to triage patients as low risk (appropriate for using single drug-regimens) or high risk (requiring multidrug-regimens) based on a-priori risk chemotherapy resistance. 1 Ngan HYS Seckl MJ Berkowitz RS et al. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet. 2018; 143: 79-85 Crossref PubMed Scopus (160) Google Scholar For patients with persistent or progressive disease, salvage therapies remain quite effective, such that 99% of patients with low-risk disease and 70% of those with high-risk disease are reported to eventually develop durable complete remission. 2 Freitas F Braga A Viggiano M et al. Gestational trophoblastic neoplasia lethality among Brazilian women: a retrospective national cohort study. Gynecol Oncol. 2020; 158: 452-459 Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar Nonetheless, there remains a fraction of patients who still either die due to disease or have significant morbidity from receiving multiple lines of chemotherapy. Camrelizumab plus apatinib in patients with high-risk chemorefractory or relapsed gestational trophoblastic neoplasia (CAP 01): a single-arm, open-label, phase 2 trialCamrelizumab plus apatinib showed promising antitumour activity and acceptable toxicity and could be a salvage therapy option for the treatment of high-risk chemorefractory or relapsed gestational trophoblastic neoplasia. Immune checkpoint inhibitors combined with chemotherapy for heavily-treated patients and upfront use of camrelizumab plus apatinib for patients with high-risk gestational trophoblastic neoplasia are under investigation in phase 2 trials. Full-Text PDF