Bell Sarah G, Uppal Shitanshu, Sakala Michelle D, Sciallis Andrew P, Rolston Aimee
University of Michigan Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
University of Michigan Department of Radiology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
Gynecol Oncol Rep. 2021 Jun 23;37:100819. doi: 10.1016/j.gore.2021.100819. eCollection 2021 Aug.
We report a case of extrauterine epithelioid trophoblastic tumor (ETT)-the rarest variant of gestational trophoblastic tumor-that has been stable on nearly two years of pembrolizumab treatment. A 47-year-old gravida 2, para 2 who underwent a prophylactic bilateral salpingo-oophorectomy nine years prior and bilateral mastectomy five years prior in the setting of a strong family history of breast and ovarian cancer with no genetic testing performed, presented to an outside clinic with recurrent respiratory infections without resolution despite antibiotics. Radiology and pathology testing confirmed the ETT diagnosis, including a second opinion from the John I. Brewer Trophoblastic Disease Center of Northwestern University's Feinberg School of Medicine, and the patient was started on a chemotherapy regimen of etoposide, methotrexate, actinomycin-D, etoposide, and cisplatin for seven cycles, with partial improvement in her disease. After PD-L1 testing showed the tumor had > 5% PD-L1 positivity, she initiated pembrolizumab in April 2019. CT imaging after three months revealed decreased lung, abdominal, and pelvic disease and she was continued on pembrolizumab. As of December 2020, she had completed 29 cycles of pembrolizumab, with a plan for her to continue treatment indefinitely given her decreased, but persistent, disease. Our findings suggest pembrolizumab is a reasonable option for treatment of patients with significant PD-L1 positivity on testing of the tumor.
我们报告了一例子宫外上皮样滋养细胞肿瘤（ETT）——妊娠滋养细胞肿瘤中最罕见的变体——在接受近两年的帕博利珠单抗治疗后病情一直稳定。一名47岁、孕2产2的女性，九年前因有强烈的乳腺癌和卵巢癌家族史且未进行基因检测而接受了预防性双侧输卵管卵巢切除术，五年前接受了双侧乳房切除术，她因反复呼吸道感染就诊于外部诊所，尽管使用了抗生素但仍未缓解。放射学和病理学检查确诊为ETT，包括西北大学费恩伯格医学院约翰·I·布鲁尔滋养细胞疾病中心的二次诊断，患者开始接受依托泊苷、甲氨蝶呤、放线菌素-D、依托泊苷和顺铂的化疗方案，共七个周期，病情有部分改善。在程序性死亡受体配体1（PD-L1）检测显示肿瘤PD-L1阳性率>5%后，她于2019年4月开始使用帕博利珠单抗。三个月后的CT成像显示肺部、腹部和盆腔疾病减轻，她继续接受帕博利珠单抗治疗。截至2020年12月，她已完成29个周期的帕博利珠单抗治疗，鉴于其病情有所减轻但仍持续存在，计划让她无限期继续治疗。我们的研究结果表明，对于肿瘤检测显示PD-L1显著阳性的患者，帕博利珠单抗是一种合理的治疗选择。
