这是国内首例报道使用免疫疗法治疗耐药妊娠滋养细胞肿瘤（GTN）的病例。一名 41 岁的 Gravida 4 Para 3 (3013)，诊断为 GTN，III 期：WHO 风险评分为 13（绒毛膜癌），最初接受 10 个周期的多种药物依托泊苷、甲氨蝶呤、放线菌素 D-环磷酰胺和长春新碱治疗(EMACO) 和 19 个周期的依托泊苷、顺铂-依托泊苷甲氨蝶呤和放线菌素 D (EP-EMA)。随着 β 人绒毛膜促性腺激素 (ßhCG) 水平持续升高，患者被转诊至滋养细胞疾病中心，那里发现肿瘤进展至大脑。她开始接受紫杉醇和卡铂 (PC) 的三线挽救化疗，同时进行全脑照射，完成三个周期，之后再次诊断出化疗耐药，hCG 滴度增加，肺部肿块数量和大小增加，被认为无法切除。使用 Pembrolizumab 开始免疫治疗，显示出良好的反应，βhCG 水平显着下降。免疫相关不良事件（irAE）的发生导致后续免疫治疗周期明显延迟。通过 irAE 的管理，又给予两个周期的 Pembrolizumab，剂量减少了 50%，βhCG 水平也相应下降。然而，患者随后出现革兰氏阴性败血症，可能患有血液系统恶性肿瘤，最后死于大面积肺栓塞。该病例强调了及时诊断和转诊至滋养细胞疾病中心以及在化疗耐药性 GTN 中使用免疫疗法的重要性。© 2024 Acta Medica Philippina。

This is the first reported case of the use of immunotherapy in chemo-resistant Gestational Trophoblastic Neoplasia (GTN) in the country. A 41-year-old, Gravida 4 Para 3 (3013) with a diagnosis of GTN, Stage III: WHO risk score of 13 (Choriocarcinoma) was initially managed with 10 cycles of multiple agent Etoposide, Methotrexate, Actinomycin D-Cyclophosphomide and Vincristine (EMACO) and 19 cycles of Etoposide, Cisplatin-Etoposide Methotrexate and Actinomycin D (EP-EMA). With continuous rise in beta human chorionic gonadotropin (ßhCG) levels, the patient was referred to a Trophoblastic Disease Center where there was note of tumor progression to the brain. She was started on third-line salvage chemotherapy of Paclitaxel and Carboplatin (PC) with concomitant whole brain irradiation completing three cycles after which chemoresistance was again diagnosed with increasing hCG titers and increase in the number and size of the pulmonary masses which were deemed unresectable. Immunotherapy was started with Pembrolizumab showing a good response with marked fall in ßhCG levels. The onset of immune-related adverse events (irAEs) caused a marked delay in subsequent cycles of immunotherapy. With management of the irAEs, two more cycles of Pembrolizumab with fifty percent dose reduction were given with corresponding drop in ßhCG levels. However, the patient subsequently developed gram-negative septicemia with possible hematologic malignancy and finally succumbed to massive pulmonary embolism. The case highlights the importance of prompt diagnosis and referral to a Trophoblastic Disease Center and the use of immunotherapy in chemo-resistant GTN.© 2024 Acta Medica Philippina.