■妊娠滋养细胞肿瘤(GTN)是一组罕见的肿瘤,其特征是妊娠后滋养细胞异常增殖,包括;浸润性痣,绒毛膜癌和中间滋养细胞肿瘤(ITT)。虽然GTN的治疗和随访是不均匀的,在全球范围内,专家网络的出现有助于协调其管理。
■我们提供当前知识的概述,诊断,以及GTN中的管理策略,并讨论正在研究的创新治疗方案。虽然化疗一直是GTN治疗的历史支柱,目前正在研究靶向PD-1/PD-L1通路的免疫检查点抑制剂和抗血管生成酪氨酸激酶抑制剂等有前景的药物,以重塑滋养细胞肿瘤的治疗前景.
■GTN的化疗方案对生育能力和生活质量有潜在的长期影响,需要创新和毒性较小的治疗方法。免疫检查点抑制剂已显示出逆转GTN免疫耐受的前景,并已在多项试验中进行了评估。然而,免疫疗法与小鼠中罕见但危及生命的不良事件和免疫相关不育的证据有关,强调需要进一步研究和仔细考虑其使用。创新的生物标志物可以帮助个性化GTN治疗并减轻某些患者的化疗负担。
Gestational trophoblastic neoplasia (GTN) is a group of rare tumors characterized by abnormal trophoblastic proliferation following pregnancy including invasive moles, choriocarcinomas, and intermediate trophoblastic tumors (ITT). Although the treatment and follow-up of GTN has been heterogeneous, globally the emergence of expert networks has helped to harmonize its management.
We provide an overview of the current knowledge, diagnosis, and management strategies in GTN and discuss innovative therapeutic options under investigation. While chemotherapy has been the historical backbone of GTN treatment, promising drugs such as immune checkpoint inhibitors targeting the PD-1/PD-L1 pathway and anti-angiogenic tyrosine kinase inhibitors are currently being investigated remodeling the therapeutical landscape of trophoblastic tumors.
Chemotherapy regimens for GTN have potential long-term effects on fertility and quality of life, making innovative and less toxic therapeutic approaches necessary. Immune checkpoint inhibitors have shown promise in reversing immune tolerance in GTN and have been evaluated in several trials. However, immunotherapy is associated with rare but life-threatening adverse events and evidence of immune-related infertility in mice, highlighting the need for further research and careful consideration of its use. Innovative biomarkers could help personalize GTN treatments and reduce chemotherapy burden in some patients.