Pharmacotherapy of gestational trophoblastic neoplasia

Abstract

Introduction: Gestational trophoblastic neoplasia (GTN) is an encompassing term for the malignant forms of gestational trophoblastic disease that require treatment with chemotherapy due to their propensity to both locally and systemically invade, and compromise survival if untreated. GTN is inherently chemotherapy sensitive with excellent cure rates; however, resistant/relapsed high-risk disease, liver/CNS metastases and placental site trophoblastic tumor can be challenging to treat. Due to rarity of the condition, there is lack of randomized trial data leading to variation in practice.Areas covered: This review covers the primary and relapse/resistant pharmacotherapy of both low- and high-risk GTN, with consideration of liver, CNS metastases and placental site trophoblastic tumor. The Pubmed and Cochrane databases have been searched with keywords – gestational trophoblastic neoplasia, gestational trophoblastic disease, low-risk GTN, high-risk GTN, relapsed GTN and placental site trophoblastic tumor.Expert opinion: Consensus is required amongst the specialist centers in defining the risk groups; hence, minimizing treatments in the low-risk group, identifying those patients at risk of relapse and tailoring treatments appropriately. While experts strive for randomized-controlled trials, international collaboration needs to continue to gather further insight into these rare diseases.