Abstract 807P
Background
Most women with gestational trophoblastic neoplasia (GTN) are cured but some die of chemoresistant disease. Here, we piloted a novel Esc-EP regimen to assess its efficacy and safety in advanced/refractory GTN.
Methods
We assessed the efficacy of Esc-EP (E 500mg/m2 + P 60mg/m2 d1 q 2-weekly) in pre-treated GTN patients (choriocarcinoma [CC], placental site trophoblastic tumour [PSTT] or epithelioid trophoblastic tumour [ETT]) treated in 4 trophoblastic centres from December 1995 to April 2021. Safety was determined by Common Terminology Criteria for Adverse Events v4.0.
Results
Esc-EP was given to 15 patients (12 CC, 2 ETT and 1 PSTT) who received a median of 6 cycles (range 3-8). Most common metastases were lung (12), brain (8) and liver (6). All CCs were high-risk (9 ultra-high risk). Median number of prior regimens was 2 (range 1-7), including 2 who had high-dose chemotherapy (HDCT). Complete response (CR) occurred in 6, and was sustained in 5 including 1 failing HDCT. The CR patient relapsing after 8 months died despite subsequent HDCT and immunotherapy (IO). 5 CC patients had a partial response (PR), including 1 failing HDCT, and subsequent CR was achieved/sustained with other therapies in 4. 1 patient with a PR died despite 2 further therapies. 1 CC had progressive disease (PD) and died despite further treatment. Median CC follow-up was 36 months (range 4-142). All ETT/PSTT patients had poor prognosis disease (FIGO stage IV and > 4 years since causative pregnancy), and a median of 3 prior therapies. Esc-EP induced a PR in 1 patient who later progressed and died despite IO. PD occurred in 1 patient who died after further treatment and 1 had stable disease before progressing and dying without more therapy. Esc-EP was well tolerated with mainly grade 1-2 toxicities. Asymptomatic grade 3/4 neutropenia occurred in 4 and thrombocytopaenia in 3 patients. Other G3 toxicities were anaemia (5), renal (1) or hearing (2) impairment, and fatigue (1).
Conclusions
Esc-EP is active in relapsed CC, contributing to salvaging 75% (9/12) CC patients. It offers a less toxic alternative to EP/EMA or Gem-TIP and can be considered in patients before/failing HDCT. Its role in PSTT/ETT is uncertain and requires further analysis.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.