What's New in Gestational Trophoblastic Disease Research and Treatment?

Important research into gestational trophoblastic disease (GTD) is being done right now in many university hospitals, medical centers, and other institutions around the country. Each year, scientists find out more about what causes the disease and how to improve treatment.

Causes of GTD

Researchers are studying cells of GTD to learn more about how these tumors develop. Discoveries about chromosome abnormalities of complete and partial moles have helped explain the causes of these types of GTD. These discoveries have led to developing lab tests that can help identify types of moles (partial vs. complete) when routine microscopic analysis does not yield a clear answer.

Epidemiology

Researchers often collect data on how often various forms of cancer occur in different parts of the world and whether these diseases are becoming more or less common. This often provides clues about risk factors and ideas for prevention. Earlier studies suggested that choriocarcinoma and GTDs were 5 to 10 times more common in Asia than in Europe and North America. More recent information indicates that the difference is actually no greater than double and may be even less, and that the original estimates were likely biased by differences in the way births are recorded in different countries.

Staging and prognosis

Newer and more sensitive tests are now able to more accurately determine blood human chorionic gonadotropin (HCG) levels than in the past. Scientists have developed a blood test for a form of HCG known as hyperglycosylated HCG. Early studies suggest that this blood test may help separate patients with active GTD who need treatment from those who have elevated HCG levels but don't truly have GTD, and therefore may not require therapy. More studies are needed to confirm this.

Improvements in the staging systems and prognostic classification systems are making it easier for doctors to recognize which patients will benefit from which treatments.

Treatment

In recent years, a number of studies have shown the benefits of using combination chemotherapy (chemo) for high-risk metastatic GTD, such as the EMA-CO and EMA-EP regimens (these were discussed in the section about chemotherapy). The excellent results with these regimens have made them treatments of choice in many institutions.

Newer chemo drugs including pemetrexed, paclitaxel, and gemcitabine have been studied for use in this disease, as are several new combinations of drugs. Some of these are already being used in women whose GTD doesn't respond to other treatments.

For tumors that are resistant to standard chemo doses, doctors are studying the use of high-dose chemo followed by a stem cell transplant to restore the patient's bone marrow. Some very early results have been promising, but more research is needed.

Researchers are also studying the benefits and risks of giving anti-cancer drugs to prevent future GTDs in women who have had a molar pregnancy in the past.

And researchers are always looking for ways to give the usual chemo drugs with new schedules that might be more effective, cause less severe side effects, and/or be more convenient for patients.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: November 10, 2017 Last Revised: November 27, 2017

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Important research into gestational trophoblastic (jeh-STAY-shuh-nul troh-fuh-BLAS-tik) disease (GTD) is being done right now in many university hospitals, medical centers, and other institutions around the country. Each year, scientists find out more about what causes this disease and how to improve treatment.

Researchers are studying GTD cells to learn more about how these tumors develop. Finding certain chromosome changes in complete and partial moles have helped explain the causes of these types of GTD. These discoveries have led to developing lab tests that can help identify these 2 types of moles (partial vs. complete) when routine testing doesn't give a clear answer. As more genetic changes are identified, researchers hope to be better able to identify and treat GTD.

Studies have suggested that human chorionic gonadotropin (hCG) blood levels may help separate women with high (hCG) levels with active GTD who need treatment from those who have high (hCG) levels, but don't have GTD and don't need treatment. More studies are looking at how this might be useful in women with high (hCG) levels, as well as in women with low hCG levels who do have GTD.

Improvements in the staging systems and prognostic classification (predicting outcomes) systems are under discussion. These changes could make it easier for doctors to recognize which patients will benefit from which treatments. It could also help researchers when comparing GTD treatments and patient outcomes.

New chemo drugs are being studied for use in this disease, as are new combinations of drugs. This could lead to more treatment options and better treatment outcomes. Researchers are also studying ways to give the usual chemo drugs with new schedules that might work better, cause less severe side effects, and/or be more convenient for patients.

For tumors that are resistant to standard chemo doses, doctors are studying the use of high-dose chemo followed by a stem cell transplant to restore the patient's bone marrow. So far results have been mixed and more research is needed.