Improving single-agent chemoresistance risk identification in gestational trophoblastic neoplasia.

Abstract

In The Lancet Oncology, Antonio Braga and colleagues 1 Braga A Paiva G Ghorani E et al. Predictors for single-agent resistance in FIGO score 5 or 6 gestational trophoblastic neoplasia: a multicentre, retrospective, cohort study. Lancet Oncol. 2021; (published online June 25.)https://doi.org/10.1016/S1470-2045(21)00262-X Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar report the results of a multicentre, retrospective study involving the largest cohort of patients with gestational trophoblastic neoplasia presenting with an International Federation of Gynaecology and Obstetrics (FIGO) risk score of 5 or 6, in a low risk setting. 2 Kohorn EI Goldstein DP Hancock BW et al. Workshop report: combining the staging system of the International Federation of Gynecology and Obstetrics with the scoring system of the World Health Organization for trophoblastic neoplasia. Report of the Working Committee of the International Society for the Study of Trophoblastic Disease and the International Gynecologic Cancer Society. Int J Gynecol Cancer. 2000; 10: 84-88 Crossref PubMed Scopus (75) Google Scholar , 3 Goldstein DP Ross S Berkowitz RS Horowitz NS Optimal management of low-risk gestational trophoblastic neoplasia. Expert Rev Anticancer Ther. 2015; 15: 1293-1304 Crossref PubMed Scopus (12) Google Scholar Indeed, in so-called low-risk patients (ie, those with stage I or stage II–III disease and a FIGO risk score of 0–6), patients can have heterogeneous outcomes in terms of chemosensitivity to single-agent chemotherapy; in particular, patients with a FIGO risk score of 0–1 have a complete remission rate of 75% compared with approximately 53% in patients with a FIGO risk score of 2–4 and approximately 33% in patients with a FIGO risk score of 5–6. 4 Sita-Lumsden A Short D Lindsay I et al. Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000–2009. Br J Cancer. 2012; 107: 1810-1814 Crossref PubMed Scopus (88) Google Scholar Therefore, whether patients with a FIGO risk score of 5–6 should be treated with a multiagent approach, which is more aggressive than a single-agent approach, is controversial, 5 Winter MC Treatment of low-risk gestational trophoblastic neoplasia. Best Pract Res Clin Obstet Gynaecol. 2021; (published online Feb 2.)https://doi.org/10.1016/j.bpobgyn.2021.01.006 Crossref PubMed Scopus (1) Google Scholar , 6 Lok C van Trommel N Massuger L Golfier F Seckl M Clinical Working Party of the EOTTDPractical clinical guidelines of the EOTTD for treatment and referral of gestational trophoblastic disease. Eur J Cancer. 2020; 130: 228-240 Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 7 Braga A Mora P de Melo AC et al. Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide. World J Clin Oncol. 2019; 10: 28-37 Crossref PubMed Google Scholar even though most patients who do not respond to first-line single-agent chemotherapy can have complete remission after second-line single-agent chemotherapy. Predictors for single-agent resistance in FIGO score 5 or 6 gestational trophoblastic neoplasia: a multicentre, retrospective, cohort studyApproximately 60% of women with gestational trophoblastic neoplasia presenting with a FIGO risk score of 5 or 6 achieve remission with single-agent therapy; almost all remaining patients have complete remission with subsequent multiagent chemotherapy. Primary multiagent chemotherapy should only be given to patients with metastatic disease and choriocarcinoma, regardless of pretreatment human chorionic gonadotropin concentration, or to those defined by our new predictors. Full-Text PDF