• Antonio Braga, Elaine Balthar, Laís Cristhine Santos Souza, Michelle Samora, Matheus Rech, José Mauro Madi, Joffre Amim Junior, FilhoJorge RezendeJRRio de Janeiro Trophoblastic Disease Center, Maternidade Escola da Universidade Federal do Rio de Janeiro, RJ, Rio de Janeiro, Brazil; Hospital Universitário Antonio Pedro da Universidade Federal Fluminense, RJ, Niterói, Brazil; Postgr, Kevin M Elias, Neil S Horowitz, Sue Yazaki Sun, and Ross S Berkowitz.
• Rio de Janeiro Trophoblastic Disease Center, Maternidade Escola da Universidade Federal do Rio de Janeiro, RJ, Rio de Janeiro, Brazil; Hospital Universitário Antonio Pedro da Universidade Federal Fluminense, RJ, Niterói, Brazil; Postgraduate Program in Perinatal Health, Faculdade de Medicina, Maternidade Escola da, Universidade Federal do Rio de Janeiro, RJ, Rio de Janeiro, Brazil; Postgraduate Program in Medical Sciences, Universidade Federal Fluminense, RJ, Niterói, Brazil; Postgraduate Program in Applied Health Sciences, Universidade de Vassouras, RJ, Rio de Janeiro, Brazil; Young Leadership Physicians Program, Academia Nacional de Medicina, RJ, Rio de Janeiro, Brazil. Electronic address: antonio.braga@ufrj.br.
• Clinics (Sao Paulo). 2023 Jan 1; 78: 100260100260.

ObjectiveTo 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.MethodsThree 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.ResultsOf 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.ConclusionImmunotherapy 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.Copyright © 2023 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

18 keywords...

hide…