Cargando…

Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases

OBJECTIVE: To evaluate the efficacy of immunotherapy for GTN treatment after methotrexate-resistance or in cases of multiresistant disease, through a systematic review, as well as to present the first 4 Brazilian cases of immunotherapy for GTN treatment. METHODS: Three independent researchers search...

Descripción completa

Detalles Bibliográficos
Autores principales: Braga, Antonio, Balthar, Elaine, Souza, Laís Cristhine Santos, Samora, Michelle, Rech, Matheus, Madi, José Mauro, Junior, Joffre Amim, Filho, Jorge Rezende, Elias, Kevin M., Horowitz, Neil S., Sun, Sue Yazaki, Berkowitz, Ross S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10404605/
https://www.ncbi.nlm.nih.gov/pubmed/37523979
http://dx.doi.org/10.1016/j.clinsp.2023.100260
_version_ 1785085336842403840
author Braga, Antonio
Balthar, Elaine
Souza, Laís Cristhine Santos
Samora, Michelle
Rech, Matheus
Madi, José Mauro
Junior, Joffre Amim
Filho, Jorge Rezende
Elias, Kevin M.
Horowitz, Neil S.
Sun, Sue Yazaki
Berkowitz, Ross S.
author_facet Braga, Antonio
Balthar, Elaine
Souza, Laís Cristhine Santos
Samora, Michelle
Rech, Matheus
Madi, José Mauro
Junior, Joffre Amim
Filho, Jorge Rezende
Elias, Kevin M.
Horowitz, Neil S.
Sun, Sue Yazaki
Berkowitz, Ross S.
author_sort Braga, Antonio
collection PubMed
description OBJECTIVE: To evaluate the efficacy of immunotherapy for GTN treatment after methotrexate-resistance or in cases of multiresistant disease, through a systematic review, as well as to present the first 4 Brazilian cases of immunotherapy for GTN treatment. METHODS: Three independent researchers searched five electronic databases (EMBASE, LILACS, Medline, CENTRAL and Web of Science), for relevant articles up to February/2023 (PROSPERO CRD42023401453). The quality assessment was performed using the Newcastle Ottawa scale for case series and case reports. The primary outcome of this study was the occurrence of complete remission. The presentation of the case reports was approved by the Institutional Review Board. RESULTS: Of the 4 cases presented, the first was a low-risk GTN with methotrexate resistance unsuccessfully treated with avelumab, which achieved remission with sequential multiagent chemotherapy. The remaining 3 cases were high-risk multiagent-resistant GTN that were successfully treated with pembrolizumab, among which there were two subsequent gestations, one of them with normal pregnancy and healthy conceptus. Regarding the systematic review, 12 studies were included, only one of them on avelumab, showing a 46.7% complete remission rate. The remaining 11 studies were on pembrolizumab, showing an 86.7% complete remission rate, regardless of tumor histology. Both immunotherapies showed good tolerability, with two healthy pregnancies being recorded: one after avelumb and another after pembrolizumab. CONCLUSION: Immunotherapy showed effectiveness for GTN treatment and may be especially useful in cases of high-risk disease, where pembrolizumab achieves a high therapeutic response, regardless of the histological type, and despite prior chemoresistance to multiple lines of treatment.
format Online
Article
Text
id pubmed-10404605
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo
record_format MEDLINE/PubMed
spelling pubmed-104046052023-08-08 Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases Braga, Antonio Balthar, Elaine Souza, Laís Cristhine Santos Samora, Michelle Rech, Matheus Madi, José Mauro Junior, Joffre Amim Filho, Jorge Rezende Elias, Kevin M. Horowitz, Neil S. Sun, Sue Yazaki Berkowitz, Ross S. Clinics (Sao Paulo) Original Articles OBJECTIVE: To evaluate the efficacy of immunotherapy for GTN treatment after methotrexate-resistance or in cases of multiresistant disease, through a systematic review, as well as to present the first 4 Brazilian cases of immunotherapy for GTN treatment. METHODS: Three independent researchers searched five electronic databases (EMBASE, LILACS, Medline, CENTRAL and Web of Science), for relevant articles up to February/2023 (PROSPERO CRD42023401453). The quality assessment was performed using the Newcastle Ottawa scale for case series and case reports. The primary outcome of this study was the occurrence of complete remission. The presentation of the case reports was approved by the Institutional Review Board. RESULTS: Of the 4 cases presented, the first was a low-risk GTN with methotrexate resistance unsuccessfully treated with avelumab, which achieved remission with sequential multiagent chemotherapy. The remaining 3 cases were high-risk multiagent-resistant GTN that were successfully treated with pembrolizumab, among which there were two subsequent gestations, one of them with normal pregnancy and healthy conceptus. Regarding the systematic review, 12 studies were included, only one of them on avelumab, showing a 46.7% complete remission rate. The remaining 11 studies were on pembrolizumab, showing an 86.7% complete remission rate, regardless of tumor histology. Both immunotherapies showed good tolerability, with two healthy pregnancies being recorded: one after avelumb and another after pembrolizumab. CONCLUSION: Immunotherapy showed effectiveness for GTN treatment and may be especially useful in cases of high-risk disease, where pembrolizumab achieves a high therapeutic response, regardless of the histological type, and despite prior chemoresistance to multiple lines of treatment. Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 2023-07-29 /pmc/articles/PMC10404605/ /pubmed/37523979 http://dx.doi.org/10.1016/j.clinsp.2023.100260 Text en © 2023 HCFMUSP. Published by Elsevier España, S.L.U. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Articles
Braga, Antonio
Balthar, Elaine
Souza, Laís Cristhine Santos
Samora, Michelle
Rech, Matheus
Madi, José Mauro
Junior, Joffre Amim
Filho, Jorge Rezende
Elias, Kevin M.
Horowitz, Neil S.
Sun, Sue Yazaki
Berkowitz, Ross S.
Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases
title Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases
title_full Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases
title_fullStr Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases
title_full_unstemmed Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases
title_short Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases
title_sort immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 brazilian cases
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10404605/
https://www.ncbi.nlm.nih.gov/pubmed/37523979
http://dx.doi.org/10.1016/j.clinsp.2023.100260
work_keys_str_mv AT bragaantonio immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT baltharelaine immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT souzalaiscristhinesantos immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT samoramichelle immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT rechmatheus immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT madijosemauro immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT juniorjoffreamim immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT filhojorgerezende immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT eliaskevinm immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT horowitzneils immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT sunsueyazaki immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases
AT berkowitzrosss immunotherapyinthetreatmentofchemoresistantgestationaltrophoblasticneoplasiasystematicreviewwithapresentationofthefirst4braziliancases