THE NATIONAL Comprehensive Cancer Network® (NCCN®) has released new treatment guidelines for a group of rare cancers that impact women during pregnancy. Gestational trophoblastic neoplasia, also known as gestational trophoblastic disease, can occur when tumors develop in the cells that would normally form the placenta during pregnancy. It happens in approximately 1 out of every 1,000 pregnancies in the United States, although it is more common in many Asian and African countries. Due to the rare nature of this condition and the small number of specialists worldwide, providers often are not aware of how to provide the best care for women with gestational trophoblastic neoplasia.
David Mutch, MD
“These guidelines are sorely needed,” explained David Mutch, MD, of Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, who leads the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Committee for gestational trophoblastic neoplasia. “By compiling expert consensus, we can standardize the way this uncommon disease is treated. When treated properly, [gestational trophoblastic neoplasia] can almost always be cured, but deviating from that standard can have severe consequences. Plus, by providing clear instructions for how best to treat [gestational trophoblastic neoplasia], we can streamline the insurance approval process for more efficient care.”
Variations of Rare Disease
THE NCCN Guidelines for gestational trophoblastic neoplasia detail treatments for several variations of the disease. For molar pregnancy (also known as a hydatiform mole, a rare mass that can form inside the womb during early pregnancy, resulting in an abnormal fetus), surgery is the first, and often only, treatment required. It is generally performed via suction dilation and curettage. In women with low-risk gestational trophoblastic neoplasia, the primary treatment is single-agent chemotherapy, although additional chemotherapy or surgery may be required for persistent disease. In women with high-risk gestational trophoblastic neoplasia, treatment typically involves multiagent chemotherapy, with possible radiation therapy for brain metastasis. Surgery can be used for chemotherapy-resistant disease.
“When treated properly, [gestational trophoblastic neoplasia] can almost always be cured, but deviating from that standard can have severe consequences.”— David Mutch, MD
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Dr. Mutch was joined on the gestational trophoblastic neoplasia committee by John Lurain III, MD, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and R. Kevin Reynolds, MD, of the University of Michigan Rogel Cancer Center. The committee is a subset of the larger NCCN Guidelines Panel for Cervical, Uterine, and Vulvar Cancers, of which all three are members.
“We’re fortunate to have several recognized experts in gestational trophoblastic neoplasia on our panel,” said Wui-Jin Koh, MD, of the Seattle Cancer Care Alliance, Chair of the NCCN Guidelines Panel for Cervical, Uterine, and Vulvar Cancers, and incoming Chief Medical Officer for NCCN. “These rare, potentially aggressive malignancies are highly curable. That’s why it’s so important to correctly diagnose, treat, and monitor people with [gestational trophoblastic neoplasia]. When patients are appropriately managed—as described in these standardized guidelines—not only do they generally achieve excellent long-term outcomes, but fertility can also be preserved for the majority of patients.”
Guidelines Offer Path to Optimize Therapy
“IF SOMEONE with a rare type of cancer doesn’t live near one of the world’s experts on that disease, it doesn’t mean their treatment path can’t be based on that expertise,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “NCCN Guidelines provide care recommendations for 97% of all cancer patients, plus numerous additional recommendations covering screening, prevention, and supportive care. We have plans to add several more new guidelines in the next year, to build our library of NCCN Harmonized Guidelines for regions with different resource levels, and to publish more translations for non–English-speaking clinicians. We know that people with cancer all over the world are relying on the NCCN Guidelines to make sure they get the best possible care for their cancer.”
The NCCN Guidelines for gestational trophoblastic neoplasia are available free-of-charge online at NCCN.org or via the virtual library of NCCN Guidelines mobile app for smartphones and tablets. ■
