NCCN Issues Gestational Trophoblastic Neoplasia Guidelines

Oncologists have new guidance when it comes to a group of rare cancers that impact women during pregnancy. The National Comprehensive Cancer Network (NCCN) has issued the first ever US guidelines for gestational trophoblastic neoplasia to ensure pregnant women with cancer receive life-saving treatment while preserving fertility.

“These guidelines were sorely needed. What we had was based on published studies and it is not what was being followed,” said David Mutch, MD, of with Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis.

Mutch, who led the NCCN clinical practice guidelines committee for gestational trophoblastic neoplasia, said these types of tumors can develop in the cells that would normally form the placenta during pregnancy. These tumors occur in approximately 1 out of every 1,000 pregnancies in the US However, they are more common in Asian and African countries.

Due to the rare nature of gestational trophoblastic neoplasia, and the small number of specialists worldwide, providers are often not aware of how to provide the best care for patients. Mutch said by compiling expert consensus, it was possible to standardize the way these tumors should treated. When treated properly, gestational trophoblastic neoplasia can almost always be cured, according to Mutch.  However, he said deviating from the standard of care can have severe consequences.

The NCCN Guidelines for gestational trophoblastic neoplasia include treatments for several variations of the disease. For hydatiform mole, surgery is the first, and often only treatment required. It is generally performed via dilation and curettage with suction. Low-risk gestational trophoblastic neoplasia is primarily treated with single-agent chemotherapy. However, additional chemotherapy or surgery may be required for persistent disease, according to the guidelines. With high-risk gestational trophoblastic neoplasia, treatment typically involves multi-agent chemotherapy, with possible radiation therapy for brain metastasis. Surgery can be used for chemotherapy-resistant disease.

Mutch said these new guidelines are very important for two reasons. First, he said they will put an end to insurance companies denying claims. He said some insurance companies were refusing to cover some procedures because there were no published guidelines. Mutch said these new guidelines now provide clear instructions for how best to treat gestational trophoblastic neoplasia. “The path will now be more clearly defined for treatment plans,” Mutch told Cancer Network.

The authors of the new guidelines note that these rare, potentially aggressive malignancies are highly curable. So, it is paramount that patients are correctly diagnosed, treated, and monitored in a fashion that preserves fertility. Robert W. Carlson, MD, the Chief Executive Officer for NCCN, said if a patient with this type of cancer doesn’t live near one of the world’s experts, it doesn’t mean their treatment path can’t be based on that expertise. He said the guidelines provide care recommendations for 97% of gestational trophoblastic neoplasia patients. In addition, they provide numerous additional recommendations covering screening, prevention, and supportive care.

Rebecca C. Arend, MD, an assistant professor in the division of gynecologic oncology at the University of Alabama at Birmingham, said these guidelines are overdue and should significantly help improve care and outcomes. “Guidelines for this disease have been desperately needed as there has been a lot of controversy around what the best care practice is. These guidelines will certainly help standardize the treatment of these patients who can normally be cured with appropriate treatment and are frequently diagnosed at a young age,” Arend told Cancer Network.