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A case report: Metastatic Gestational Trophoblastic Neoplasia leading to acute respiratory failure and death.About a particularly challenging management in the intensive care unit, and exploring the potential of Pembrolizumab in treating frail pretreated Gestational Trophoblastic Neoplasia

par Meyers, Michel ;Awada, Ahmad ;Najmaoui, Marine;Ilzkovitz, Maxime ;Pezzullo, Martina ;Chaves, Julia;Devière, Jacques ;Halenarova, Katarina ;Georgala, Aspasia ;Fastrez, Maxime ;Goffin, Frédéric M.S. ;Polastro, Laura
Référence Case reports in oncology, page (1-23)
Publication Publié, 2025-02

Article révisé par les pairs

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:Case presentation:We present the case of a 37-year-old female patient who developed an acute respiratory failure requiring mechanical ventilation, two months after term delivery by cesarian section. The diagnosis of gestational trophoblastic neoplasia was suspected due to high level of HCG in post-partum period and thoracic imaging suggesting multiple pulmonary metastases. No biopsy was available. She subsequently developed severe ARDS requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) support alongside concurrent polychemotherapy. After spending 61 days in the intensive care unit (ICU), and achieving biological complete remission based on HCG monitoring, the patient was transferred to the oncology ward. Due to prolonged hypoperfusion and hypoxemia the patient developed ischemic cholangiopathy, severely constraining further therapeutic options. After 4 months of biological remission, the patient experienced a recurrence based on HCG rising and reappearing of pulmonary lesions on thoracic imaging in the lungs. In second-line, the patient was treated with carboplatin, with no significant response. In third-line, Pembrolizumab was used, and the patient experienced a significant decrease in HCG. However, due to hematologic toxicity, we discontinued the treatment. Subsequently, HCG level raised and the patient rapidly developed hemorrhagic cerebral metastasis and succumbed shortly thereafter.Conclusion:This case underscores the importance of prompt recognition and timely intervention in the management of patients with ARDS during the early postpartum period. GTN with lung involvement should be considered after excluding the other more frequent causes of ARDS. It also highlights how ECMO support enables the continuation of chemotherapy and the achievement of remission in choriocarcinoma. Furthermore, due to the inability to initiate the desired chemotherapy, immunotherapy was introduced as a possible treatment modality. Therefore, this case underscores the importance of adaptability in treatment plans based on patient-specific clinical conditions and collaborative decision-making with specialized centers. Finally, it emphasizes the efficacy of Pembrolizumab, even as a monotherapy, in pre-treated choriocarcinoma cases.