Gestational trophoblastic neoplasm: Patient outcomes and clinical pearls from a multidisciplinary referral center.

Objectives: To describe clinical outcomes and pearls for patients with gestational trophoblastic neoplasm (GTN).
Methods: Patients with GTN treated at a referral center from 1/2006 to 12/2022 were included. Clinical characteristics, World Health Organization risk score (low-risk 0-6, high-risk ≥7), and treatments/outcomes were evaluated using summary statistics, stratified by initial treatment at a referral center versus locally. Histologies included complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT).
Results: Of 189 patients with GTN, 125 were treated initially at a referral center and 64 locally. Median age at diagnosis was 34 years (range, 17-70). Most patients were White (n = 132, 70 %); 80 patients had CHM, 26 PHM, 52 CCA, 11 PSTT, 19 ETT, and 1 ETT/CCA. For low-risk GTN, first-line treatment was primarily methotrexate, although some were cured with repeat dilation and curettage. For high-risk disease, first-line therapy consisted of multiagent chemotherapy regimens at a referral center (n = 18/18) compared to 7 of 15 patients with high-risk GTN treated with methotrexate at local institutions. Patients with low-risk and high-risk disease who received initial care at a tertiary referral institution had cure rates of 100 % (n = 87/87) and 89 % (n = 16/18), respectively, while patients with initial care locally had cure rates of 87 % (n = 33/37) and 47 % (n = 7/15), respectively.
Conclusion: GTN is a rare gynecologic malignancy with high cure rates, particularly in low-risk disease. Treatment consolidation at a tertiary referral institution is critical for improved outcomes, particularly in those with high-risk disease or PSTT/ETT.
Competing Interests: Declaration of competing interest B. Weigelt reports research funding from REPARE Therapeutics and SAGA Diagnostics paid to the institution, and has an immediate family member who is employed at AstraZeneca. N. Abu-Rustum reports research funding paid to the institution from GRAIL. C. Aghajanian reports clinical trial funding to the institution from AbbVie – MSK PI, GOG3005; AstraZeneca – MSK PI, SOLO1/GOG 3004; National Coordinating Investigator & MSK PI, D081RC00001; ENGOT-ov6; AGO-OVAR 23; GOG-3025; Clovis – MSK PI, Ariel 2 & 3 and Genentech/Roche-MSK PI, GOG3015 (1Magyn050). Y.L. Liu reports research funding to the institution from AstraZeneca, GSK/Tesaro, Repare Therapeutics and Artios Pharma; advisory board participation for Myriad Laboratories; and payment/honoraria from Topline Bio and HMP Education. K. Devereaux is a full-time employee of Merck & Co., Inc. (Rahway, NJ, USA). The other authors have no conflicts of interest to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)