NCCN Releases New Guidelines for Rare Cancers During Pregnancy

Earlier this month, the National Comprehensive Cancer Network (NCCN) released new treatment guidelines for a group of rare cancers that impact women during pregnancy. These are the first US guidelines for rare cancers associated with pregnancy.

Gestational trophoblastic neoplasia (GTN) presents in about 1 out of every 1000 pregnancies in the United States and can occur when tumors develop in cells that would normally form the placenta during pregnancy. Due to the rarity of the condition, physicians may not be familiar with the disease or how to provide the best care for patients with GTN.

All NCCN guidelines consist of the following factors: algorithms and flowcharts to provide guidance for the clinical decision-making process, discussion text describing the data and clinical information that supports the recommendations in the algorithms, references to support the evidence of the recommendations, and disclosure of potential conflicts of interest of panel members and NCCN headquarters staff.

The guidelines provide an overview of treatment options for several variations of the disease. For example, in an instance of a molar pregnancy, or a rare mass that can form inside the womb during early pregnancy resulting in an abnormal fetus, surgery is the first and oftentimes only treatment required. Low-risk GTN is treated primarily with single-agent chemotherapy, though surgery may be required for persistent disease. Surgery can also be used for chemotherapy-resistant disease, and for patients with high-risk GTN, treatment will typically include multi-agent chemotherapy as well as possible radiation therapy for brain metastasis.

“These guidelines are sorely needed. By compiling expert consensus, we can standardize the way this uncommon disease is treated,” said David Mutch, MD, Siteman Cancer Center at Barnes-Jewish Hospital and Washington School of Medicine in a statement. “When treated properly, GTN can almost always be cured, but deviating from that standard can have severe consequences. Plus, by providing clear instructions for how best to treat GTN, we can streamline the insurance approval process for more efficient care.”

The guidelines were developed in conjunction with several recognized experts in the treatment of GTN and brings the total number of NCCN guidelines to 72.