妊娠滋养细胞肿瘤药物治疗的现状及进展

Current Status and Progress on Medical Treatment of Gestational Trophoblastic Disease

妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)是一类少见的恶性肿瘤,也是较早即可通过化疗治愈的肿瘤。国内外指南建议,在选择化疗方案的时候应依据于危险分层,低危GTN患者首选单药化疗。在2018年FIGO关于GTN诊治指南更新中,强调了对低危患者的进一步分层处理。对于5～6分及病理诊断为绒癌的患者,单药化疗的耐药率增加,可以放宽标准直接选择联合化疗。随着肿瘤治疗的进展,新药物、新方法也在GTN中应用,但资料仍然比较有限。多重耐药、复发的GTN患者仍然是治疗的难点。对这些患者,大剂量化疗联合自体干细胞移植可能是一个治疗选择。免疫治疗的成功报道也是鼓舞人心的,有可能成为高危、耐药患者的新选择。不过,GTN中免疫检测点抑制剂的作用机制并不完全清楚,治疗的长期疗效、毒副反应和对远期生育力的影响均尚不明确。免疫治疗在整个GTN治疗中的地位仍然需要探讨。

Gestational trophoblastic neoplasia ( GTN ) is a group of rare malignant tumors. It was the first metastatic cancer to be cured by chemotherapy. The choice of chemotherapy is based on risk stratification. The majority of low risk patients can be cured with single agent chemotherapy. In the updated GTN guidelines revised by FIGO in 2018, further stratification of low-risk patients was highlighted. Higher FIGO score (5 ~6) and clinicopathologic diagnosis of choriocarcinoma are both associated with an increased risk of resistance to single agent chemotherapy. Lowering the threshold for the use of multiple agent chemotherapy in these low-risk patients can be considered. With the progress in cancer treatment, new drugs and methods are also applied in GTN, but the data are still limited. Multi-drug resistance and recurrence patients remain difficult to cure. High-dose chemotherapy combined with autologous stem cell transplantation may be an option for these patients. Recent work suggests that checkpoint immunotherapies may also save some of these patients. However, the mechanism of checkpoint inhibitors is poorly understood, and the long-term efficacy or side effects of treatment is under cleared. The status of immunotherapy in the treatment of GTN remains to be explored.