Document Type

Report

Publication Date

9-16-2026

Comments

This article is the author’s final published version in Gynecologic Oncology Reports, Volume 67, 2026, Article number 102209.

The published version is available at https://doi.org/10.1016/j.gore.2026.102209. Copyright © 2026 The Authors.

 

Abstract

BACKGROUND: Epithelioid Trophoblastic Tumors (ETT) are rare, which makes an optimal treatment regimen difficult to determine. Since PD-L1 is expressed in placental tissue and in gestational trophoblastic neoplasia (GTN), immunotherapies such as pembrolizumab have been proposed as possible treatments.

CASE PRESENTATION: The case presented is a 50-year-old postmenopausal female who presented with postmenopausal bleeding and a large, fungating cervical mass. Cervical biopsies confirmed ETT. The patient underwent primary debulking surgery with radical abdominal hysterectomy, bilateral salpingo-oophorectomy, and sigmoid colon resection. The patient was diagnosed with a FIGO Stage IV ETT due to tumor extension to sigmoid colon with a high-risk WHO score of 12. She underwent four cycles of etoposide and cisplatin with etoposide, methotrexate, and dactinomycin (EP-EMA) followed by six months of pembrolizumab maintenance. One year after completion of immunotherapy, the patient was diagnosed with recurrence by vaginal biopsy. PET/CT revealed oligometastatic sites of recurrence, prompting secondary debulking surgery with upper vaginectomy and removal of incisional recurrence. After four cycles of cisplatin/paclitaxel and etoposide/paclitaxel (TP-TE), she received maintenance pembrolizumab for 12 months. Follow-up PET/CT scans revealed no evidence of hypermetabolic activity after 1 year of maintenance therapy.

CONCLUSION: Use of immunotherapy with anti-PD-1 inhibitors has been successful in cases of GTN due to expression of PD-L1 in placental tissue and in GTN. This case adds to the limited data on immunotherapy in advanced ETT and is the first example of using immunotherapy after immunotherapy in the literature.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

42824962

Language

English

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