2019 Gestational Trophoblastic Disease (GTD)
Gestational trophoblastic disease, or GTD, refers to a group of pregnancy-related tumors. If you or someone you know has received a diagnosis for a certain type of GTD, this can be a very stressful and emotional time. But most cases are highly curable, and advances are being made in the treatment of recurrent and rare, more aggressive types of GTD.
Prevention
If you have been diagnosed with a type of GTD, know that there was nothing you could have done to prevent it. In very rare cases, women may have a strong family history of GTD or experience several molar pregnancies or miscarriages. In these rare cases, genetic counseling may be advisable. If certain gene mutations are found, women may want to consider using a donor egg to achieve a normal pregnancy. Again, these incidences are very rare.
Advances in Treatment
The most common type of GTD is called hydatidiform mole. These are usually benign. Of the cases that develop a malignancy after this diagnosis, nearly 100 percent are curable if properly managed. Therefore, early detection and proper treatment from a gynecologic oncologist are imperative. Women who experience a single case of hydatidiform mole, even if they receive chemotherapy, are expected to achieve normal subsequent pregnancies.
Most forms of GTD are close to being 100% curable
Immunotherapies for Recurrent GTN
About 15 to 20 percent of complete molar pregnancies develop into gestational trophoblastic neoplasia (GTN), a malignant form of GTD. The vast majority of these cases are treated successfully with standard chemotherapy treatment.
In rare cases, women with GTN may not respond to standard chemotherapy, even after multiple cycles of treatment. Immunotherapies are being explored as an option for these women. Recent reports show that some women with chemotherapy-resistant GTN respond well to immunotherapies when multiple cycles of chemotherapy have failed.
Researchers are studying whether immunotherapies can be initiated earlier in the treatment process for recurrent or high-risk patients with GTN. A clinical trial called TROPHIMMUN is underway in France. This trial is investigating immunotherapy in chemotherapy-resistant patients with GTN and is aimed at finding a more targeted agent that is less toxic and more beneficial. This is of particular importance for women who are of childbearing age and are interested in preserving their fertility.
Immunotherapies are one of the most exciting advances developed in the last few years to treat GTN. It brings the field one step closer to a 100 percent cure rate for all women diagnosed with GTN.
Second Curettage for Low-Risk GTN
Women who develop hydatidiform mole undergo what’s called a curettage, or surgical removal of the abnormal pregnancy from the uterus. Despite the removal of the abnormal cells, some women go on to develop a malignancy. The most common treatment for these women is standard chemotherapy.
However, the Gynecologic Oncology Group, in collaboration with the National Cancer Institute, completed a trial in 2015 that evaluated the effectiveness of a second curettage as an alternative to chemotherapy to treat women with low-risk GTN. This study showed that about a third of women were cured after a second curettage and were able to avoid chemotherapy altogether. Therefore, a second curettage provides an alternative option for appropriately selected patients in the management of GTN.
New Standard of Care for GTD
GTD-related tumors are rare. Therefore, a small number of specialists around the U.S. have experience in treating this disease. This means some women may not have access to care locally. However, two major factors are improving the outlook for patients with GTD, no matter where they are located:
- Vital research is being conducted on GTD around the U.S. at various university hospitals, medical centers and institutions. If your treating physician is not affiliated with one of these centers, or is not familiar with the nature of your type of GTD, they should strongly consider consulting with a specialist at one of these centers.
- The National Comprehensive Cancer Network (NCCN) recognized the need to standardize care for this rare group of pregnancy-related tumors. The NCCN Guidelines for Gestational Trophoblastic Neoplasia were published in 2018 to establish for physicians the standard of care for the diagnosis, treatment and follow-up of patients with GTD.
One way to find a specialist is through our Seek a Specialist tool, where you can search for a gynecologic oncologist within a certain radius of a specified location.
Clinical Trials
The Foundation for Women’s Cancer, the NCCN and other health care organizations all believe that the best management of any patient with cancer is in a clinical trial. These trials lead to discoveries of the nature of each type of cancer, which ultimately lead to the development of safer treatments and better outcomes. Without clinical trials, research would cease, and no new developments would occur.
Learn more about clinical trials and how you can participate.
FAQs
Will I have a successful pregnancy after GTD?
If you wish to become pregnant again after experiencing benign GTD or postmolar GTN, the chances of a successful pregnancy are excellent, as long as you complete hormone follow-up prescribed by your doctor and wait the recommended amount of time before becoming pregnant again. Your chances of achieving a normal pregnancy following GTD is about the same as the general population.
More than 98 percent of women who become pregnant following a molar pregnancy will not experience another hydatidiform mole. These subsequent pregnancies will not be at higher risk for complications.
When can I become pregnant again?
This is one of the most commonly asked questions that gynecologic oncologists receive. After a partial or complete molar pregnancy, your provider will determine how long you need to monitor your pregnancy hormone levels (hCG) and ensure that no malignancies develop. If you should need chemotherapy to treat trophoblastic disease, the follow-up time is at least 12 months. If you do not need chemotherapy treatment, the typical follow-up time is six months. There are growing data to support that the follow-up time can be shortened to three months.
Specialists are looking for ways to shorten these follow-up periods further so that patients can become pregnant sooner after GTD.
GTD is rare but highly treatable
