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Consensus statement
Gestational choriocarcinoma
  1. Giorgio Bogani1,
  2. Isabelle Ray-Coquard2,3,
  3. David Mutch4,
  4. Ignace Vergote5,
  5. Pedro T Ramirez6,
  6. Jaime Prat7,
  7. Nicole Concin8,
  8. Natalie Yan Li Ngoi9,
  9. Robert L Coleman10,
  10. Takayuki Enomoto11,
  11. Kazuhiro Takehara12,
  12. Hannelore Denys13,
  13. Domenica Lorusso14,
  14. Masashi Takano15,
  15. Satoru Sagae16,
  16. Pauline Wimberger17,
  17. Yakir Segev18,
  18. Se Ik Kim19,
  19. Jae-Weon Kim20,
  20. Fernanda Herrera21,
  21. Andrea Mariani22,
  22. Rebecca A Brooks23,
  23. David Tan9,
  24. Biagio Paolini24,
  25. Valentina Chiappa25,
  26. Mariangela Longo26,
  27. Francesco Raspagliesi27,
  28. Pierluigi Benedetti Panici28,
  29. Violante Di Donato29,
  30. Giuseppe Caruso30,
  31. Nicoletta Colombo31,
  32. Sandro Pignata32,
  33. Gianfranco Zannoni33,
  34. Giovanni Scambia34 and
  35. Bradley J Monk35
  1. 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  2. 2 Centre Leon Berard, LYON CEDEX 08, France
  3. 3 Hesper lab, Université Claude Bernard Lyon 1, Villeurbanne, France
  4. 4 Washington University in Saint Louis, St Louis, Missouri, USA
  5. 5 Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
  6. 6 Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
  7. 7 Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  8. 8 Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria
  9. 9 National University Cancer Institute, Singapore
  10. 10 Sarah Cannon Research Institute, Nashville, Tennessee, USA
  11. 11 Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Belgium
  12. 12 Department of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
  13. 13 Medical Oncology, University Hospital Ghent, Gent, Belgium
  14. 14 Policlinico Gemelli, Rome, Italy
  15. 15 Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
  16. 16 Gynecologic Oncology, Tokeidai Kinen Byoin, Sapporo, Japan
  17. 17 Gyncology and Obstetrics, Technische Universitat Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
  18. 18 Obstetrics and Gynecology, Carmel Hospital, Haifa, Israel
  19. 19 Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea (the Republic of)
  20. 20 Obstetrics and gynecology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  21. 21 Centre Hospitalier Universitaire Vaudois Departement doncologie CHUV-UNIL, Lausanne, Switzerland
  22. 22 Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
  23. 23 Section of Gynecologic Oncology, University of Chicago Medicine, Chicago, Illinois, USA
  24. 24 Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
  25. 25 Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
  26. 26 University of Insubria, Varese, Italy
  27. 27 Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  28. 28 Obstetrics and Gynecology, University Sapienza of Roma, Rome, Italy
  29. 29 Department of Gynecology Obstetrics and Urological Sciance, Rome, Italy
  30. 30 University of Rome La Sapienza, Rome, Italy
  31. 31 Medical Gynecologic Oncology Unit; University of Milan Bicocca; Milan; Italy, European Institute of Oncology, Milano, Italy
  32. 32 Gynaecological Oncology, National Cancer Institute Napels, Naples, Italy
  33. 33 Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  34. 34 Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
  35. 35 Virginia G Piper Cancer Center – Biltmore Cancer Center, Phoenix, Arizona, USA
  1. Correspondence to Dr Giorgio Bogani, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano 20133, Italy; bogani.giorgio{at}gmail.com

Abstract

Gestational choriocarcinoma accounts for 5% of gestational trophoblastic neoplasms. Approximately 50%, 25%, and 25% of gestational choriocarcinoma occur after molar pregnancies, term pregnancies, and other gestational events, respectively. The FIGO scoring system categorizes patients into low (score 0 to 6) and high risk (score 7 or more) choriocarcinoma. Single-agent and multi-agent chemotherapy are used in low- and high-risk patients, respectively. Chemotherapy for localized disease has a goal of eradication of disease without surgery and is associated with favorable prognosis and fertility preservation. Most patients with gestational choriocarcinoma are cured with chemotherapy; however, some (<5.0%) will die as a result of multi-drug resistance, underscoring the need for novel approaches in this group of patients. Although there are limited data due to its rarity, the treatment response with immunotherapy is high, ranging between 50–70%. Novel combinations of immune checkpoint inhibitors with targeted therapies (including VEGFR-2 inhibitors) are under evaluation. PD-L1 inhibitors are considered a potential important opportunity for chemo-resistant patients, and to replace or de-escalate chemotherapy to avoid or minimize chemotherapy toxicity. In this review, the Rare Tumor Working Group and the European Organization for Research and Treatment of Cancer evaluated the current landscape and further perspective in the management of patients diagnosed with gestational choriocarcinoma.

  • Genital Neoplasms, Female
  • Gestational Trophoblastic Disease

https://doi.org/10.1136/ijgc-2023-004704

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    Footnotes

    • Twitter @pedroramirezMD, @rcoledude, @DenysHannelore, @gcarusomd

    • Contributors Conceptualization: GB, BJM. Methodology: all authors. Project administration: PTR, BJM. Supervision: PTR, BJM. Writing – original draft: all authors. Writing – review and editing: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Competing interests not related to the topic of this investigation: GB: Novartis AG Pharma (C/A, H), Italian Ministry of Health (RG); NC: AstraZeneca (C/A, SH), Seattle Genetics (C/A, SH), MSD (SAB), Mersana (C/A, SH), eTheRNA immunotherapies NV (C/A, SH), Roche (travel expenses), Genmab (travel expenses), Amgen (travel expenses). IR-C: honoraria from AstraZeneca, Clovis, GSK/Tesaro, and PharmaMar; consulting/advisory board fees from AstraZeneca, Roche, Clovis, GSK/Tesaro, Genmab, PharmaMar, MSD, Mersana, Deciphera, OncXea, Esai, BMS, Novartis, and Pfizer; research funding from MSD; travel expenses from AstraZeneca, GSK, and Roche. YS: AstraZeneca (CA), GSK (CA). PW: Amgen (SH, RF, SAB), AstraZeneca (SH, RF, H, SAB), Clovis (SH, RF, SAB), Eisai (SH, SAB), GSK (SH, SAB), Lilly (SH, SAB), MSD (SH, RF, SAB), Novartis (SH, RF, SAB), Pfizer (SH, RF, SAB), Roche (SH, RF, H, SAB), TEVA (SH, SAB). NYLN: AstraZeneca (SH), Janssen (SH). KT: AstraZeneca (SH), Chugai (SH, RF), Eisai (SH), MSD (SH), Mochida (SH), Takeda (SH). RLC: Leadership: Onxeo; Stock and Other Ownership Interests: McKesson; Consulting or Advisory Role: Clovis Oncology, Genentech/Roche, AstraZeneca/MedImmune, Genmab, Tesaro, OncoMed, Sotio, Oncolytics, AbbVie/Stemcentrx, ImmunoGen, AbbVie, Agenus, Novocure, Merck, OncXerna Therapeutics, Alkermes, Gradalis, Regeneron; Research Funding: AstraZeneca/MedImmune, Esperance Pharmaceuticals, Array BioPharma, Clovis Oncology, Johnson & Johnson, Merck, Roche/Genentech, Abbott/AbbVie, ImmunoGen (Inst), Mirati Therapeutics (Inst), Amgen (Inst), Pfizer (Inst), Lilly (Inst), Regeneron (Inst); Travel, Accommodations, Expenses: Merck, AstraZeneca/MedImmune, Array BioPharma, Clovis Oncology, Roche/Genentech, Research to Practice, GOG Foundation, Sotio, Vaniam GroupTE: Takeda (SH), Astra Zeneca (SH), Eisai (SH), Chugai Pharma (SH, RF), MSD (SH), Mochida (SH). DL: AstraZeneca (H, CA), Clovis (H, CA, RF), GSK/Tesaro (H, CA), Roche (CA), Genmab (CA), PharmaMar (CA, RF), MSD (CA, RF), Esai (CA), Merck Serono (CA), Novartis (CA), and PharmaMar (H); consulting/advisory board fees from AstraZeneca, Roche, Clovis, GSK/Tesaro. NC, advisory board membership for AstraZeneca, Clovis Oncology, Eisai, GSK, Immunogen, Mersana, MSD/Merck, Nuvation Bio, Onxerna, Pfizer, Pieris, Roche; fees as an invited speaker for AstraZeneca, Novartis, Clovis Oncology, GSK, MSD/Merck; institutional research grants from AstraZeneca, and Roche. BJM: AstraZeneca (SH, SAB), GSK (SH, SAB), Incyte (SAB), Merck (SH, SAB), Roche/Genentech (SH, SAB), Eisai (SAB), GOG-Foundation (E), US Oncology (E).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.