Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN).
Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN).
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目前关于妊娠滋养细胞肿瘤（GTN）免疫疗法的证据。
作者：
妊娠滋养细胞肿瘤（GTN）是一种罕见的肿瘤，由胎盘组织恶变引起。根据国际妇产科联合会（FIGO）解剖分期和FIGO预后评分评估，若评分小于等于6分、大于6分、大于12分，则将GTN分为低危组、高危组和超高危组。标准治疗是化疗，对于低风险疾病使用单一药物，对于高风险和超高风险 GTN 使用多药物化疗。在耐药形式的 GTN 中，使用免疫检查点抑制剂（例如抗 PD-1 或抗 PD-L1/2）可能代表一种新的治疗策略。在这项研究中，我们评估了免疫检查点抑制剂用于 GTN 治疗的现有证据。背景：妊娠滋养细胞疾病包括一组罕见的源自异常滋养细胞增殖的良性和恶性肿瘤。恶性形式称为妊娠滋养细胞肿瘤 (GTN)，包括侵袭性葡萄胎、绒毛膜癌、胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤。 GTN 的标准治疗是化疗。治疗方案的选择主要取决于FIGO预后评分。低风险和高风险 GTN 分别采用单药或多药化疗进行治疗。在化疗耐药的情况下，免疫疗法可能代表一种新的治疗策略。方法：回顾了 PubMed 上有关 GTN 和免疫治疗的检索文献。结果：程序性细胞死亡 1 (PD-1) 及其配体 (PD-L1/2) 在 GTN 中表达。已发表的关于 GTN 中单独使用 PD-1/PD-L1 抑制剂的数据适用于 51 名患者。 Pembrolizumab 是一种抗 PD-1 抑制剂，用于耐药形式的 GTN。在 TROPHIMMUN 试验中，Avelumab（一种抑制 PD-L1 的单克隆抗体）仅在对单一化疗耐药的 GTN 患者中显示出有希望的结果。相反，对于多药化疗耐药的患者，由于严重毒性和疾病进展而停止 Avelumab 治疗。卡瑞利珠单抗和阿帕替尼的结合可能代表了对多种化疗难治或复发的 GTN 形式的不同治疗方法。结论：抗 PD-1 或抗 PD-L1 可能代表治疗耐药/难治性 GTN 的一种重要的新治疗策略。
Gestational trophoblastic neoplasia (GTN) is a rare tumor group that arises from the malignant transformation of placental tissue. Based on the evaluation of International Federation of Gynecology and Obstetrics (FIGO) anatomic staging and FIGO prognostic score, GTN is divided into low-, high-, and ultra-high-risk groups if the score obtained is less than or equal to 6, greater than 6 or greater than 12, respectively. The standard treatment is chemotherapy, using a single agent in low-risk disease and multiagent chemotherapy in high- and ultra-high-risk GTN. In chemoresistant forms of GTN, the use of immune checkpoint inhibitors, such as anti-PD-1 or anti-PD-L1/2, could represent a new therapeutic strategy. In this study, we evaluate the available evidence on immune checkpoint inhibitors for GTN treatment. 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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影响因子：
8.8
作者：
El-Helw, LM;Seckl, MJ;Hancock, BW
通讯作者：
Hancock, BW
DOI：
10.1016/j.bpobgyn.2021.01.005
发表时间：
2021-07-13
影响因子：
5.5
作者：
Braga, Antonio;Elias, Kevin M.;Berkowitz, Ross S.
通讯作者：
Berkowitz, Ross S.
影响因子：
5
作者：
Frega G;Kepp O;Turchetti D;Rizzo A;Pantaleo MA;Brandi G
通讯作者：
Brandi G
影响因子：
51.1
作者：
Cheng, Hongyan;Zong, Liju;Xiang, Yang
通讯作者：
Xiang, Yang
影响因子：
45.3
作者：
Alifrangis, Constantine;Agarwal, Roshan;Seckl, Michael J.
通讯作者：
Seckl, Michael J.