Cancer Management and Research (Jun 2022)
Case Report: First-Line Immune Checkpoint Inhibitor Plus Chemotherapy for Oral Metastasis in a Patient with Ultra High-Risk Gestational Choriocarcinoma
Abstract
Yu Chen,1,* Haiyan Ye,2,* Jiming Tang,3 Yihan Weng,4 Jie Zhang,5 Jianhua Liu4 1Department of Pathology, Guangdong Provincial People’s Hospital, Second Clinical Medical College of Southern Medical University, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China; 2Department of Gynecology, Guangdong Provincial People’s Hospital, Second Clinical Medical College of Southern Medical University, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China; 3Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Second Clinical Medical College of Southern Medical University, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China; 4Department of Oncology, Guangdong Provincial People’s Hospital, Second Clinical Medical College of Southern Medical University, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China; 5Department of Radiology, Zhuhai City People’s Hospital, Zhuhai Hospital of Jinan University, Zhuhai, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianhua Liu, Department of Oncology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 123 Huifu Road West, Guangzhou, 510180, People’s Republic of China, Tel + 86 20 8188 4713, Fax + 86 20 8188 3300, Email [email protected] Jie Zhang, Department of Radiology, Zhuhai City People’s Hospital/Zhuhai Hospital of Jinan University, 79 Kangning Road, Xiangzhou District, Zhuhai, 519000, People’s Republic of China, Tel +86 756 2222 569, Fax +86 756 2218 950, Email [email protected]: Choriocarcinoma (CC) tends to metastasize early into various organs and may exhibit peculiar clinical behaviors specific to metastases. Although chemotherapy has revolutionized the survival of most patients, the mortality rate remains high in cases at ultra high-risk, which may be associated with multiple organs involvement and intolerable toxicity resulting from combination chemotherapy. Here, we illustrate a 46-year-old woman patient with oral and lung lesions whose clinical and morphological heterogeneity misled the preliminary diagnosis. According to the initial pathological report of oral squamous cell carcinomas with lung metastasis and a combined positive score = 100, she received first-line immunotherapy plus two-drug chemotherapy, which obtained a surprisingly favourable outcome. Then, CC was identified by a high level of beta human chorionic gonadotropin (β-HCG) in serum and biopsies. DNA polymorphic analysis revealed its gestational origin, and a more aggressive standard regimen was subsequently implemented. However, the patient suffered repeated vomiting and myelosuppression, and the duration of treatment was significantly prolonged. Ultimately, she succumbed to death. The clinical course of this report helps to improve the understanding of this disease. We consider immune checkpoint inhibitors as potential first-line alternatives for ultra-high-risk CC patients, which provide a therapeutic reference for clinicians.Keywords: choriocarcinoma, oral metastasis, ultra high-risk, immunotherapy
