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Advances in current and emerging therapeutics for gestational trophoblast malignancies

ABSTRACT Introduction: Gestational Trophoblastic Neoplasia (GTN) are a group of rare malignancies arising from the cells of conception. GTN was the first metastatic cancer to be cured with chemotherapy and nearly all of today’s patients can expect to be cured with modern drug treatment. Based on the experience of the GTN unit at Charing Cross Hospital in London, the historical, current and forthcoming management of this biologically unique malignancy will be reviewed. Areas covered: This review will cover the classification and epidemiology of molar pregnancies, gestational choriocarcinoma and PSTT/ETT. The current approaches to management for low, high and ultra high-risk patients and the recent impact of immunotherapy for chemotherapy resistant disease are discussed. Expert opinion: GTN form a group of rare but highly curable malignancies. The unique biology of the cancer cells makes them extremely sensitive to chemotherapy and also to immunotherapy and overall cure rates approach 100%. Optimising the organisation of care for this rare group of malignancies increases the cure rates and minimise adverse outcomes. Current immunotherapy research may allow patients to access curative treatment with lower toxicity and reduced long term side effects compared to prolonged treatment with cytotoxic drugs.