滋养细胞肿瘤的管理:证据回顾、当前实践和未来方向。

IF 2.9 3区 医学 Q2 ONCOLOGY Expert Review of Anticancer Therapy Pub Date : 2023-07-01 Epub Date: 2023-05-22 DOI:10.1080/14737140.2023.2215438
Antoine Deleuze, Christophe Massard, Fanny Le Du, Benoit You, Claudia Lefeuvre-Plesse, Pierre-Adrien Bolze, Thibault de la Motte Rouge
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引用次数: 0

摘要

导言:妊娠滋养细胞肿瘤(GTN)是一组罕见肿瘤,其特点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 的治疗和随访方法各不相同,但在全球范围内,专家网络的出现有助于协调其管理:我们概述了 GTN 的现有知识、诊断和管理策略,并讨论了正在研究的创新治疗方案。虽然化疗一直是GTN治疗的历史性支柱,但目前正在研究针对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格局:GTN的化疗方案可能会对生育能力和生活质量产生长期影响,因此有必要采用创新的低毒性治疗方法。免疫检查点抑制剂有望逆转GTN的免疫耐受,并已在多项试验中进行了评估。然而,免疫疗法与罕见但危及生命的不良事件有关,而且有证据表明小鼠存在免疫相关性不孕症,这凸显了进一步研究和慎重考虑其使用的必要性。创新的生物标志物有助于个性化 GTN 治疗,并减轻一些患者的化疗负担。
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Management of trophoblastic tumors : review of evidence, current practice, and future directions.

Introduction: 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.

Areas covered: 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.

Expert opinion: 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.

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来源期刊
CiteScore
5.10
自引率
3.00%
发文量
100
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anticancer Therapy (ISSN 1473-7140) provides expert appraisal and commentary on the major trends in cancer care and highlights the performance of new therapeutic and diagnostic approaches. Coverage includes tumor management, novel medicines, anticancer agents and chemotherapy, biological therapy, cancer vaccines, therapeutic indications, biomarkers and diagnostics, and treatment guidelines. All articles are subject to rigorous peer-review, and the journal makes an essential contribution to decision-making in cancer care. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.
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