Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, 610 University Ave, Toronto, ON, M5G2M9, Canada.
Division of Gynecologic Oncology, Princess Margaret Cancer Centre/Sinai Health Systems, Toronto, ON, Canada.
Curr Treat Options Oncol. 2022 Jul;23(7):1035-1043. doi: 10.1007/s11864-022-00988-8. Epub 2022 May 5.
Most individuals with gestational trophoblastic neoplasia (GTN) are cured with chemotherapy; however, about 5% of them will develop chemotherapy-resistant disease and will die of disease progression. Most GTN tissues express programmed death ligand-1 (PDL-1), making immune checkpoint inhibitors (ICIs) targeting this pathway an attractive treatment option for individuals with GTN. There is increasing evidence to support the use of ICIs for individuals with recurrent or resistant GTN, but available data are derived from case reports and small single arm trials. As promising as it seems, not all individuals with GTN respond to ICIs, and there is lack of evidence toward which factors mediate the effect of ICIs on GTN. In addition, treatment-related adverse events and impact on future fertility are not negligible and should be considered before initiating this treatment. Therefore, additional research is needed to evaluate treatment outcome of ICIs in GTN compared to standard treatment, and to identify molecular and clinical predictors for treatment response, before this treatment is incorporated into the standard of care.
大多数患有妊娠滋养细胞肿瘤（GTN）的患者可以通过化疗治愈；然而，约有 5%的患者会发展为化疗耐药性疾病，并因疾病进展而死亡。大多数 GTN 组织表达程序性死亡配体-1（PDL-1），这使得针对该途径的免疫检查点抑制剂（ICI）成为 GTN 患者的一种有吸引力的治疗选择。越来越多的证据支持将 ICI 用于复发性或耐药性 GTN 患者，但现有数据来自病例报告和小单臂试验。尽管看起来很有希望，但并非所有 GTN 患者对 ICI 都有反应，而且缺乏关于哪些因素介导 ICI 对 GTN 影响的证据。此外，治疗相关的不良反应和对未来生育能力的影响不容忽视，在开始这种治疗之前应予以考虑。因此，在将这种治疗纳入标准治疗之前，需要进行更多的研究，以评估 ICI 在 GTN 中的治疗效果与标准治疗相比，以及确定治疗反应的分子和临床预测因素。
