Long-term survival in multiresistant metastatic choriocarcinoma after pembrolizumab treatment: A case report

Paspalj, V; Polterauer, Stephan; Poetsch, Nina; Reinthaller, Alexander; Grimm, Christoph; Bartl, Thomas

doi:10.1016/j.gore.2021.100817

Cited by 13 publications

(13 citation statements)

References 18 publications

(18 reference statements)

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“…Immunohistochemical analysis showed the expression of PD-L1 in 90% of tumor cells and in 5% of immune cells. Based on these findings, she was treated with seven cycles of Pembrolizumab, achieving complete disease remission twenty-four months after the end of treatment [ 52 ].…”

Section: Resultsmentioning

confidence: 99%

Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN)

Mangili

Sabetta

Cioffi

et al. 2022

Cancers

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Background: Gestational trophoblastic disease includes a rare group of benign and malignant tumors derived from abnormal trophoblastic proliferation. Malignant forms are called gestational trophoblastic neoplasia (GTN) and include invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Standard treatment of GTN is chemotherapy. The regimen of choice mainly depends on the FIGO prognostic score. Low-risk and high-risk GTN is treated with single-agent or multiagent chemotherapy, respectively. In the case of chemoresistance, immunotherapy may represent a new therapeutic strategy. Methods: Literature obtained from searches on PubMed concerning GTN and immunotherapy was reviewed. Results: Programmed cell death 1 (PD-1) and its ligands (PD-L1/2) are expressed in GTN. Published data on PD-1/PD-L1 inhibitors alone in GTN were available for 51 patients. Pembrolizumab is an anti-PD-1 inhibitor used in chemoresistant forms of GTN. In the TROPHIMMUN trial, Avelumab, a monoclonal antibody inhibiting PD-L1, showed promising results only in patients with GTN resistant to monochemotherapy. Conversely, in patients with resistance to multiagent chemotherapy, treatment with Avelumab was discontinued due to severe toxicity and disease progression. The association of Camrelizumab and Apatinib could represent a different treatment for forms of GTN refractory to polychemotherapy or for relapses. Conclusions: Anti-PD-1 or anti-PD-L1 might represent an important new treatment strategy for the management of chemoresistant/refractory GTN.

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Section: Resultsmentioning

confidence: 99%

Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN)

Mangili

Sabetta

Cioffi

et al. 2022

Cancers

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“…In 2017, experts from Charing Cross Hospital in the United Kingdom reported for the first time that drug-resistant CC patients who received pembrolizumab achieved a complete response. 31 Next, Huang et al 29 and Paspalj et al 32 showed the dramatic efficacy of pembrolizumab in cases with recurrent CC. Despite the favorable outcome and safety of ICIs for CC, they are currently implemented only in salvage treatment.…”

Section: Discussionmentioning

confidence: 99%

Case Report: First-Line Immune Checkpoint Inhibitor Plus Chemotherapy for Oral Metastasis in a Patient with Ultra High-Risk Gestational Choriocarcinoma

Chen¹,

Yé²,

Tang³

et al. 2022

CMAR

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Choriocarcinoma (CC) tends to metastasize early into various organs and may exhibit peculiar clinical behaviors specific to metastases. Although chemotherapy has revolutionized the survival of most patients, the mortality rate remains high in cases at ultra high-risk, which may be associated with multiple organs involvement and intolerable toxicity resulting from combination chemotherapy. Here, we illustrate a 46-year-old woman patient with oral and lung lesions whose clinical and morphological heterogeneity misled the preliminary diagnosis. According to the initial pathological report of oral squamous cell carcinomas with lung metastasis and a combined positive score = 100, she received first-line immunotherapy plus two-drug chemotherapy, which obtained a surprisingly favourable outcome. Then, CC was identified by a high level of beta human chorionic gonadotropin (β-HCG) in serum and biopsies. DNA polymorphic analysis revealed its gestational origin, and a more aggressive standard regimen was subsequently implemented. However, the patient suffered repeated vomiting and myelosuppression, and the duration of treatment was significantly prolonged. Ultimately, she succumbed to death. The clinical course of this report helps to improve the understanding of this disease. We consider immune checkpoint inhibitors as potential first-line alternatives for ultra-high-risk CC patients, which provide a therapeutic reference for clinicians.

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“…Multiple case reports supporting the efficacy and low toxicity of pembrolizumab in gestational trophoblastic neoplasia have subsequently been published. [23][24][25][26][27] Across these reports, 12 out of 17 patients with multidrug-resistant disease went on to have human chorionic gonadotropin normalization. The majority had PD-L1 expression of >90% and treatment was well tolerated throughout.…”

Section: Checkpoint Immunotherapy Has Revolutionized Cancer Carementioning

confidence: 99%

Novel approaches to managing gestational trophoblastic tumors in the age of immunotherapy

Hennah

Seckl

Ghorani

2023

Int J Gynecol Cancer

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The discovery that anti-programmed death-1 antibody (anti-PD-1) immunotherapy can cure patients with multidrug-resistant gestational trophoblastic neoplasia provides a new powerful and low toxicity treatment. This heralds an era within which the majority of patients, including those with previously difficult to treat disease, can expect to achieve long-term remission. This development should prompt a rethink of how patients with this rare disease are managed, focusing on maximizing cure rate with minimal exposure to toxic chemotherapy.

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Long-term survival in multiresistant metastatic choriocarcinoma after pembrolizumab treatment: A case report

Cited by 13 publications

References 18 publications

Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN)

Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN)

Case Report: First-Line Immune Checkpoint Inhibitor Plus Chemotherapy for Oral Metastasis in a Patient with Ultra High-Risk Gestational Choriocarcinoma

Novel approaches to managing gestational trophoblastic tumors in the age of immunotherapy

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