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Vivod G, Merlo S, Kovacevic N. High-Grade Serous Ovarian Cancer during Pregnancy: From Diagnosis to Treatment. Curr Oncol 2024; 31:1920-1935. [PMID: 38668047 PMCID: PMC11048790 DOI: 10.3390/curroncol31040144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/10/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Due to the rarity of ovarian cancer diagnosed during pregnancy, the literature on the treatment of subtypes of epithelial ovarian cancer in pregnancy is sparse. The aim of our review was to analyze cases of high-grade serous ovarian cancer in pregnancy. METHODS The PubMed and Scopus databases were searched for relevant articles published in English between January 2000 and December 2023. The references of all the relevant reviews found were also checked to avoid omitting eligible studies. Information on the all retrieved cases was extracted and reviewed in detail. The most important detail was the subtype of high-grade serous ovarian cancer, which was referred to as serous adenocarcinoma (grade 2 or grade 3) in older cases. RESULTS We found eleven cases with relevant details of high-grade serous ovarian cancer diagnosed in pregnancy. Despite the small number of cases we found, our study demonstrated the importance of an accurate initial vaginal ultrasound at the first examination in pregnancy and the safety of diagnostic surgery and chemotherapy in pregnancy. CONCLUSIONS There have not been long-term follow-ups of patients' oncologic and obstetric outcomes. As patients should be comprehensively informed, more detailed case reports or series with longer follow-up periods are needed.
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Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boskin, 4270 Jesenice, Slovenia
| | - Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boskin, 4270 Jesenice, Slovenia
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Romano A, Mastrangelo S, Attina G, Maurizi P, Ruggiero A. Pregnancy-associated Cancer and Chemotherapy during Pregnancy. BIOMEDICAL AND PHARMACOLOGY JOURNAL 2023; 16:705-714. [DOI: 10.13005/bpj/2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The diagnosis of pregnancy-associated cancer, although rare, is a condition of great human and social significance and difficult clinical management. A pregnancy-associated neoplasm is defined as a cancer diagnosis made during pregnancy or within 12 months after delivery/abortion. The most common cancers in pregnancy occur most frequently in women of reproductive age with an incidence overall like that observed in non-pregnant women of the same age. This incidence is likely to increase in view of both the expected increase in certain malignancies among young women (particularly breast cancer and melanoma) and the increasing frequency of pregnancies undertaken later in life (fourth and fifth decades of life) that is characterizing modern society. Chemotherapy is generally contraindicated before 12 weeks of pregnancy due to the increased risk of congenital anomalies while exposure in the second and third trimester of pregnancy to chemotherapy has been associated with more growth restriction and preterm delivery. Clinical decisions about the optimal management should consider maternal and fetal characteristics with the involvement of a multidisciplinary team.
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Affiliation(s)
- Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Giorgio Attina
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
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3
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Xing N, Wang L, Sui X, Zhao C, Huang Y, Peng J. The Safety of Chemotherapy for Ovarian Malignancy during Pregnancy. J Clin Med 2022; 11:jcm11247520. [PMID: 36556136 PMCID: PMC9784446 DOI: 10.3390/jcm11247520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Data on epidemiologic features, treatments and outcomes in women diagnosed with ovarian malignancy during pregnancy are very sparse due to its low incidence. The goal of our study was to summarize the epidemiologic characteristics of pregnant women complicated with ovarian malignancy and investigate the safety and efficacy of chemotherapy during pregnancy. METHODS We retrospectively analyzed the clinicopathological data of eight patients suffering from ovarian malignancy during pregnancy in our institution from June 2011 to July 2021. Furthermore, a systematic literature search was conducted in PubMed up to 1 September 2021, which identified 92 cases with ovarian malignancy during pregnancy eligible for the analysis. Therefore, we collected the data of 100 pregnant patients complicated with ovarian malignancy, including clinical demographics, tumor characteristics, treatment interventions and outcomes. RESULTS In total, 100 pregnant patients complicated with ovarian malignancy were investigated and classified into three groups: 34 cases in the epithelial ovarian cancer (EOC) group, 38 cases in the germ cell tumors (GCTs) group and 28 cases in the sex cord-stromal tumors (SCSTs) group. The onset age of pregnant patients with epithelial ovarian cancer was significantly higher than that of other patients. Pelvic mass and abdominal pain were the common clinical presentations of pregnant patients with ovarian malignancy. For distinguishing epithelial ovarian cancer during pregnancy, the area under the curve (AUC) of CA-125 was 0.718 with an optimal cutoff value of 58.2 U/mL. Moreover, 53 patients underwent surgery during pregnancy, the majority of whom underwent unilateral adnexectomy in the second trimester. Furthermore, 43 patients received chemotherapy during pregnancy, and 28 delivered completely healthy newborns at birth; 13 neonates showed transient abnormalities without further complications; and 2 died during the neonatal period. CONCLUSIONS Our study reveals the safety of chemotherapy for ovarian malignancy during pregnancy. However, large-sample prospective studies are still needed to further explore the safety of chemotherapy in pregnant patients with malignancy to choose the appropriate chemotherapy regimen and achieve the maximum benefit for patients.
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Affiliation(s)
- Naidong Xing
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Lihui Wang
- Gynecology Center, Qingdao Women and Children’s Hospital, Qingdao 266034, China
| | - Xinlei Sui
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250001, China
| | - Chunru Zhao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Yan Huang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Jin Peng
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
- Correspondence:
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Transplacental Passage and Fetal Effects of Antineoplastic Treatment during Pregnancy. Cancers (Basel) 2022; 14:cancers14133103. [PMID: 35804875 PMCID: PMC9264939 DOI: 10.3390/cancers14133103] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In this paper we perform an introduction about pregnancy-associated cancer (PAC) and transplacental passage of antineoplastic agents. Furthermore, we describe therapeutic use and potential toxic effects of chemotherapeutic drug (alkylating agents, antimetabolites agents, anthracyclines, topoisomerase inhibitors, antimitotic agents, actinomycin-D, bleomycin) and targeted agents during pregnancy. This manuscript may be a useful and practical guide for the management of PAC, which is a challenge for clinicians that have to consider alike maternal benefits and fetal potential risks correlated to the antineoplastic treatment. Abstract The incidence of PAC is relatively infrequent among pregnant women. However, it has gradually increased in recent years, becoming a challenging area for clinicians that should take into account in the same way maternal benefits and fetal potential risks correlated to the antineoplastic treatment. None of the antineoplastic drugs is completely risk-free during the pregnancy, the timing of exposure and transplacental transfer properties influence the toxicity of the fetus. Despite the lack of guidelines about the management of PAC, several studies have described the use and the potential fetal and neonatal adverse events of antineoplastic drugs during pregnancy. We provide a review of the available literature about the transplacental passage and fetal effects of chemotherapy and targeted agents, to guide the clinicians in the most appropriate choices for the management of PAC.
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Bouab M, Elazzouzi E, El Miski F, Jalal M, Lamrissi A, Fichtali K, Bouhya S, Beliamime I, Khouaja A, Karkouri M. Rare association of the ovarian adenocarcinoma with pregnancy: A case report. Ann Med Surg (Lond) 2022; 75:103350. [PMID: 35198187 PMCID: PMC8850659 DOI: 10.1016/j.amsu.2022.103350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 12/03/2022] Open
Abstract
The association of ovarian malignancy with pregnancy is rare; accounting for 3–6% of ovarian masses of which malignant germ cell tumors represent the type most frequently associated with pregnancy, whereas the incidence of epithelial ovarian cancer is only 1/12,000 to 1/50,000 of pregnancies. The diagnosis and management of ovarian cancer in pregnancy remain poorly codified because of the rarity of cases and the limited data available on this pathology. We report here the case of a 45-year-old woman with a large ovarian mucinous adenocarcinoma diagnosed during pregnancy, identified by ultrasound and magnetic resonance imaging. The patient was treated by surgical resection followed by adjuvant chemotherapy with carboplatin and paclitaxel with a follow-up of 36 months, she is in complete remission. The association of ovarian malignancy with pregnancy is rare. The timing of delivery in patients with ovarian cancer again depends on stage and gestational age. The therapeutic approach should focus on a multidisciplinary team integrating gynecologic oncology, perinatology, and neonatology services.
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Affiliation(s)
- Maryem Bouab
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Corresponding author. 1 rue des hôpitaux, Morocco.
| | - Elhassane Elazzouzi
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Fatiha El Miski
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mohamed Jalal
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Amine Lamrissi
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Karima Fichtali
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Said Bouhya
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Imane Beliamime
- Pathology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ayoub Khouaja
- Pathology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mehdi Karkouri
- Pathology Department, University Hospital Center Ibn Rochd, Casablanca, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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Pei Y, Gou Y, Li N, Yang X, Han X, Huiling L. Efficacy and Safety of Platinum-Based Chemotherapy for Ovarian Cancer During Pregnancy: A Systematic Review and Meta-Analysis. Oncol Ther 2021; 10:55-73. [PMID: 34865206 PMCID: PMC9098723 DOI: 10.1007/s40487-021-00179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Based on the available data on ovarian cancer during pregnancy, we performed a review and meta-analysis to evaluate the efficacy and safety of platinum-based chemotherapy against ovarian cancer during pregnancy. Methods We systematically searched three databases including the PubMed, Embase, and Cochrane Library databases for articles published from January 1986 to December 2020 using the following terms: “ovarian tumors OR ovarian carcinoma OR adnexal masses OR ovarian cancer” AND “pregnancy” AND “chemotherapy.” Two authors (Yaping Pei and Yuanfeng Gou) independently searched the literature and extracted data from each eligible study. The outcome measures were overall survival (OS) and progression-free survival (PFS). The OS and PFS of all patients were estimated by Kaplan–Meier survival curves and log-rank tests. Results A total of 43 studies including 55 cases of ovarian cancer during pregnancy were selected. Forty-eight patients were comprehensively staged using the International Federation of Gynecology and Obstetrics (FIGO) staging system. Twenty-six of the 48 patients (54.17%) were diagnosed with early-stage disease, while the remaining had advanced stages (II, III, and IV). The mean age at diagnosis was 29.31 years. The majority of patients in this meta-analysis were diagnosed at a mean gestational age of 16.05 weeks. The mean GA at chemotherapy administration was 17.42 weeks. Overall, 55 women gave birth to 56 newborns, including a pair of twins. At the end of follow-up (median 10 months, range 0–73 months), all the children were healthy, except for one child who died 5 days after delivery due to a congenital abnormality. During 2–204 months of follow-up, there were five cases of recurrence, with no evidence of recurrence in the remaining cases. Unfortunately, one patient died 29 months after diagnosis. Neither median overall survival nor median progression-free survival was obtained. Conclusion Platinum-based chemotherapy may be a good choice for pregnant women with ovarian cancer who want to continue their pregnancy. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-021-00179-9.
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Affiliation(s)
- Yaping Pei
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Yuanfeng Gou
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Na Li
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Xiaojuan Yang
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Xue Han
- Department of Gynecology and Obstetrics, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, China
| | - Liu Huiling
- Department of Gynecology and Obstetrics, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, China.
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Jiang X, Ye Z, Yu W, Fang Q, Jiang Y. Chemotherapy for ovarian cancer during pregnancy: A systematic review and meta-analysis of case reports and series. J Obstet Gynaecol Res 2021; 47:3425-3436. [PMID: 34342108 DOI: 10.1111/jog.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aims to investigate the safety and efficacy of chemotherapy in ovarian cancer patients in pregnancy. METHODS In this study, eligible studies were searched on PubMed, Embase, and Cochrane Library databases up to December 31, 2020. Data were calculated and presented by frequency and percentage, mean ± standard deviation (SD), and median (range), respectively. Kaplan-Meier survival analysis was performed to estimate overall survival (OS) and progression-free survival (PFS). RESULTS Finally, 34 studies including 40 ovarian cancer cases receiving chemotherapy during pregnancy were included. All 40 patients received chemotherapy during pregnancy. During the follow-up, seven of 37 (18.9%) women had a relapse and four of them (4/7, 57.1%) died of recurrence. Survival analysis failed to reach median OS and PFS within the follow-up (range 3-72 months). Better OS and PFS after chemotherapy in pregnancy were obtained in women with early-stage ovarian cancer (I) compared with those with advanced stage (III-IV). Neither OS nor FS differed between women treated with multi-drugs and those with monotherapy. Forty-one newborns were delivered from 40 pregnant women. Thirty-four (34/41, 82.9%) were completely healthy at birth and the end of follow-up (range 0.18-160 months). However, one newborn died 5 days after birth due to multiple congenital malformations, and another one developed Tourette's syndrome, aphasia, Asperger's syndrome as well as speech delay. CONCLUSIONS This meta-analysis first reveals the efficacy and safety of chemotherapy for ovarian cancer during pregnancy, especially for early-stage patients. Cisplatin or carboplatin is suggested to be used as monotherapy to reduce adverse effects.
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Affiliation(s)
- Xingzhi Jiang
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhongxue Ye
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Wen Yu
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Qian Fang
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yafen Jiang
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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8
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Wang M, Yin Z, Miao J, Wu Y. The fetal outcomes after neoadjuvant platinum and paclitaxel chemotherapy during pregnancy: analysis of three cases and review of the literature. Arch Gynecol Obstet 2021; 305:49-54. [PMID: 34115181 DOI: 10.1007/s00404-021-06113-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Data on the outcomes of fetus who are exposed to neoadjuvant platinum and paclitaxel chemotherapy during pregnancy are lacking. METHODS Relevant data were abstracted from patients in our institution, PubMed, Embase and Cochrane Library databases. The primary assessment was the frequency of fetal death and congenital abnormalities. The secondary assessment was other negative fetal/infant outcomes including FGR, RDS, secondary malignant diseases and other recorded adverse events. RESULTS Of the three infants in our center who exposed to platinum and paclitaxel chemotherapy during pregnancy, the physical evaluation and qualified Denver Developmental Screening Test showed normal findings at the last follow-up (19-24 months). Hearing evaluation among three children also showed normal findings. Another 34 infants (including a twins) of 21 studies in previous studies who exposed to platinum and paclitaxel chemotherapy during pregnancy were included in the final analysis. Of the 37 infants identified, 24 were exposed to cisplatin plus paclitaxel, and 13 were exposed to carboplatin plus paclitaxel. None of the 37 fetuses was abortion or dead during the pregnancy. 97.3% (36/37) infants were delivered by cesareans and the median gestational ages of delivery were 34.76 weeks (95% CI, 34.08-35.44). 1 fetus showed intrauterine growth restriction and one was found with left-sided ventriculomegaly and hydramnios before chemotherapy. Adverse events occurred in 18.9% (7/37) infants at birth, including two RDS, one hearing loss, one pathological jaundice, one first-degree intraventricular hemorrhage, one erythema, one corresponding to -0.5 standard deviation from average body weight of the same gestational weeks. No reports of neonatal cardiologic abnormalities are reported in these infants after the initiating of chemotherapy. The infant with congenital anomaly died 5 days after birth. During the follow-up, 5.4% (2/37) of the infants were diagnosed with malignant diseases. One retroperitoneal embryonal rhabdomyosarcoma at 5 years old and one acute myeloid leukemia at 22 months of age. 32/37 (86.5%) children were healthy at the end of follow-ups (median 33 months, IQR 15.75-54.25 months). CONCLUSIONS Our results showed that neoadjuvant platinum and paclitaxel combined chemotherapy was a feasible and safe choice for the management of patients with cervical and ovarian cancer during the second and third trimesters of gestation.
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Affiliation(s)
- Ming Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qihelou St, Dongcheng District, Beijing, 100006, China
| | - Ziran Yin
- Department of Common Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jinwei Miao
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qihelou St, Dongcheng District, Beijing, 100006, China
| | - Yumei Wu
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qihelou St, Dongcheng District, Beijing, 100006, China.
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Guo Y, Zhang D, Li Y, Wang Y. A case of successful maintained pregnancy after neoadjuvant chemotherapy plus radical surgery for stage IB3 cervical cancer diagnosed at 13 weeks. BMC Pregnancy Childbirth 2020; 20:202. [PMID: 32264960 PMCID: PMC7140335 DOI: 10.1186/s12884-020-02895-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background Cervical cancer during pregnancy is rare. The management for stage IB3 during pregnancy remains unclear and challenging. We report a successful preserved pregnancy in a stage IB3 patient who was treated with neoadjuvant chemotherapy (NACT) plus radical surgery. Case presentation A 36-year-old pregnant woman was diagnosed with a 5-cm-diameter stage IB3 squamous cell carcinoma of the uterine cervix at 13 gestational weeks. The patient received 5 courses of systemic chemotherapy with carboplatin and paclitaxel every 3 weeks, followed by caesarean section and radical hysterectomy. Both the mother and infant are in good general condition. Conclusion This case suggests that NACT plus radical surgery could be one method to maintain pregnancy in stage IB3 cervical cancer diagnosed as early as 13 gestational weeks.
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Affiliation(s)
- Ying Guo
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Orignal Diseases, Shanghai, China
| | - Dandan Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuhong Li
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Yudong Wang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,Shanghai Key Laboratory of Embryo Orignal Diseases, Shanghai, China.
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Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, Halaska MJ, Hasenburg A, Johansson ALV, Lambertini M, Lok CAR, Maggen C, Morice P, Peccatori F, Poortmans P, Van Calsteren K, Vandenbroucke T, van Gerwen M, van den Heuvel-Eibrink M, Zagouri F, Zapardiel I. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol 2019; 30:1601-1612. [PMID: 31435648 DOI: 10.1093/annonc/mdz228] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
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Affiliation(s)
- F Amant
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - P Berveiller
- Department of Obstetrics and Gynecology, Centre Hospitalier de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - I A Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, USA
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - M Fumagalli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - A Hasenburg
- Department of Obstetrics and Gynecology, Mainz University Medical Center, Mainz, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Lambertini
- Department of Medical Oncology, IRCCS Policlinico San Martino Hospital, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C A R Lok
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands
| | - C Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - P Morice
- Department of Gynecologic Surgery, Institute de Cancérologie Gustave Roussy, Villejuif, France
| | - F Peccatori
- Department of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Department of Radiation Oncology, Institut Curie and Paris Sciences & Lettres - PSL University, Paris, France
| | - K Van Calsteren
- Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | | | - M van Gerwen
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - F Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, Athens, Greece
| | - I Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
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Zagouri F, Korakiti AM, Zakopoulou R, Kyriazoglou A, Zografos E, Haidopoulos D, Apostolidou K, Papatheodoridi MA, Dimopoulos MA. Taxanes during pregnancy in cervical cancer: A systematic review and pooled analysis. Cancer Treat Rev 2019; 79:101885. [PMID: 31442939 DOI: 10.1016/j.ctrv.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cervical cancer is one of the most common malignancies diagnosed during pregnancy. Taxanes administration has been established as theurapetic regimen in non pregrant women. OBJECTIVES This systemic review and meta-analysis aims to synthesize all available data from cervical cancer series in pregnant women and evaluate the efficacy and safety of taxanes during pregnancy. SEARCH STRATEGY Eligible articles were identified by a search of ClinicalTrial.gov and MEDLINE databases for the period 01/01/2000 up to 31/11/2017; The algorithm consisted of a predefined combination of the words "cervical", "cancer", "taxanes" and "pregnancy". SELECTION CRITERIA PRISMA guidelines were applied in this study. The literature search and data extraction from all studies that examined the efficacy and safety of taxanes in pregnancy, were done by two independent investigators. Quantitative synthesis of the published articles was performed. DATA COLLECTION AND ANALYSIS Overall eight articles were retrieved. In all cases (14 pregnancies, 14 newborns) the use of taxanes in combination with platinum derivatives resulted in the birth of alive neonates, with not any miscarriage. The taxane derivative used in all cases was paclitaxel, combined with Cisplatin (13 pregnancies) and Carboplatin (one pregnancy). RESULTS Complete and partial response was achieved in 7.2% and 92.9% of cervical cancer patients. In the majority of cases chemotherapy was well tolerated. The median progression-free survival was 48.5 months. CONCLUSION Taxanes administration during the 2nd and 3rd trimester of pregnancy is a safe choice.
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece.
| | - Anna-Maria Korakiti
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece
| | | | - Eleni Zografos
- Department of Basic Medical Sciences, Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Haidopoulos
- 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, University of Athens, Medical School, Greece
| | - Kleoniki Apostolidou
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece
| | | | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece
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12
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Le Guevelou J, Lebars S, Kammerer E, de Gabory L, Vergez S, Janot F, Baujat B, Righini C, Jegoux F, Dufour X, Merol JC, Mauvais O, Lasne-Cardon A, Selleret L, Thariat J. Head and neck cancer during pregnancy. Head Neck 2019; 41:3719-3732. [PMID: 31329334 DOI: 10.1002/hed.25877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The incidence of cancer during pregnancy is low but is slightly increasing. Data on incidence and etiology of head and neck (HN) cancers in pregnant women are rare. We evaluated the frequency, tumor type, associated factors, and specific biomarkers in HN cancers occurring in pregnant (and peripartum) women. METHODS A systematic literature search was performed on PubMed, for any HN tumor site occurring in pregnant women. RESULTS Sixty cases of HN cancers occurring during pregnancy were identified. Most of them were oral cavity cancers. Relationships with oncogenic viruses, hormonal disturbance, and shift in maternal immunity profile were identified. CONCLUSION Carcinogenesis of HN cancers in pregnant women may be led by different cancer type-specific hallmarks. Relevance of these etiological factors with respect to treatments and birth control recommendations is being investigated by the REFCOR in an ambispective study.
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Affiliation(s)
| | | | | | - Ludovic de Gabory
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pellegrin, Bordeaux, France
| | - Sebastien Vergez
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Rangueil-Larrey, Toulouse, France
| | - François Janot
- Service de Chirurgie ORL, Centre Gustave Roussy, Villejuif, France
| | - Bertrand Baujat
- Service de Chirurgie ORL, Hopital Tenon, Université Paris-Est, Paris, France
| | - Christian Righini
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Franck Jegoux
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Xavier Dufour
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-Claude Merol
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Olivier Mauvais
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Audrey Lasne-Cardon
- Service de Chirurgie ORL Centre François Baclesse, Normandie Université-Unicaen, Caen, France
| | - Lise Selleret
- Service de Gynécologie Obstetrique, Hopital Tenon, Paris, France
| | - Juliette Thariat
- Service de Radiothérapie, Centre François Baclesse, Caen, France
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13
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Boussios S, Moschetta M, Tatsi K, Tsiouris AK, Pavlidis N. A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives. J Adv Res 2018; 12:1-9. [PMID: 29988841 PMCID: PMC6032492 DOI: 10.1016/j.jare.2018.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/21/2022] Open
Abstract
The management of gestational ovarian cancer can be challenging because of the risk of fetal wastage, and the possibility of treatment-related complications to the fetus; it is based on insufficient data from retrospective studies and case series. Here, a literature review of the diagnostic and surgical approaches to the gestational ovarian cancer has been performed; moreover, data on safety of chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes, have also been reviewed. Up to now, 193 cases of ovarian cancers during pregnancy have been reported in the English literature. Treatment of ovarian malignancies during pregnancy depends on histology, stage, and gestational weeks. When possible, surgical excision is indicated, and fertility-sparing surgery can be offered to stage I epithelial ovarian tumours (EOC), germ cell ovarian, or sex-cord stromal ovarian tumours. Neoadjuvant and/or adjuvant chemotherapy for advanced ovarian tumours is indicated as in non-pregnant women. Administration of chemotherapy after the first trimester, can cause fetal growth restriction, while being seemingly safe. The therapeutic approach of ovarian cancer in pregnancy should be individualized and intended in specialized centers.
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Affiliation(s)
- Stergios Boussios
- Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
- Corresponding author.
| | - Michele Moschetta
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London W1G 6AD, UK
| | - Konstantina Tatsi
- Gynaecology Unit, General Hospital “G. Hatzikosta”, Makrigianni Avenue, 45001 Ioannina, Greece
| | - Alexandros K. Tsiouris
- Department of Biological Applications & Technology, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
| | - Nicholas Pavlidis
- Medical School, University of Cyprus, Old road Lefkosias Lemesou, No. 215/6, 2029 Aglantzia, Nicosia, Cyprus
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14
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Gynecologic Malignancies in Pregnancy: Balancing Fetal Risks With Oncologic Safety. Obstet Gynecol Surv 2017; 72:184-193. [PMID: 28304416 DOI: 10.1097/ogx.0000000000000407] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Cancer occurs in 0.05% to 0.1% of all pregnancies. Despite literature reporting good oncologic and fetal outcomes in women treated for cancer during pregnancy, as many as 44% of gynecologists would offer termination, and 37% would not administer chemotherapy or radiotherapy in pregnancy. Objectives The aims of this study were to summarize current recommendations for the treatment of cervical and ovarian cancers in pregnancy and to review updates on existing knowledge regarding the safety of surgical and chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes. Evidence Acquisition A detailed literature review was performed on PubMed. Results The treatment of gynecologic malignancies during pregnancy mirrors that outside pregnancy, with a balance between maternal versus fetal health. Fertility-sparing surgery can be offered to stage IA2 and low-risk IB1 cervical, stage I epithelial ovarian, germ cell ovarian, or sex-cord stromal ovarian tumors. Delayed treatment can be offered for stage IB1 cervical cancer. Neoadjuvant and/or adjuvant chemotherapy can be given for advanced gynecologic cancers with good disease-free survival without significant adverse neonatal outcomes. Conclusions A multidisciplinary approach and improved education of providers regarding the surgical and chemotherapeutic treatments in pregnancy are needed in order to fully inform patients regarding treatment options. Further research in women who are pregnant is needed to determine the safety of diagnostic and therapeutic procedures used in the nonpregnant woman. Relevance This article reviews and supports treatment of gynecologic cancer during pregnancy, calls for additional study and long-term follow-up, and justifies improved education of patients and providers regarding treatment options. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to (1) review general principles in the management and treatment of gynecologic cancers in pregnancy, (2) review the diagnosis and treatment of cervical cancer in pregnancy, and (3) review the diagnosis and treatment of ovarian cancer in pregnancy.
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15
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Hummeida ME, Hamad K, Gadir AFA, Ali AA. Ovarian Cancer During Pregnancy: A Case Report and Literature Review. Clin Pract 2015; 5:727. [PMID: 26236450 PMCID: PMC4500872 DOI: 10.4081/cp.2015.727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/12/2015] [Accepted: 03/11/2015] [Indexed: 11/23/2022] Open
Abstract
Ovarian cancer during pregnancy is a rare event. Little is known about the treatment of this condition due to lack of prospective randomized trials and cohort studies. In this paper the authors reported a rare case of small cells ovarian cancer, diagnosed at 16 weeks of gestation, treated with conservative surgery at 18 weeks and chemotherapy. At week 38, the patient underwent caesarean section and delivered a healthy baby girl. Staging surgery was then carried out followed by adjuvant chemotherapy. Thus the findings from this case concluded that prognosis and quality of the patient’s life should be a priority, chemotherapy during the second trimester seems to be safe however, potential risks of this interventions still has to be considered.
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16
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Blake EA, Kodama M, Yunokawa M, Ross MS, Ueda Y, Grubbs BH, Matsuo K. Feto-maternal outcomes of pregnancy complicated by epithelial ovarian cancer: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 2015; 186:97-105. [PMID: 25668134 DOI: 10.1016/j.ejogrb.2015.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/31/2014] [Accepted: 01/13/2015] [Indexed: 12/27/2022]
Abstract
Although cancer diagnosed during pregnancy is rare, epithelial cell type ovarian cancers (EOCs) comprise approximately one quarter to one half of cases of ovarian malignancy diagnosed during pregnancy. The behavior of EOC during pregnancy and its implications for maternal and fetal outcomes is not well understood. In order to better define these outcomes, a systematic literature search was conducted in PubMed/MEDLINE using entry keywords "pregnancy" and "ovarian cancer" for the period from 1955 to 2013. The literature search identified 105 cases eligible for analysis. Clinical characteristics, pregnancy outcome, tumor characteristics, clinical management, and survival outcomes were all evaluated. Serious adverse events were defined as complications related to EOC that resulted in severe morbidity or mortality for the mother and/or fetus. The mean age of cases was 31.6 years. The most common histology was serous (47.6%), followed by mucinous (27.6%) and endometrioid types (10.5%). The most common presenting symptom was abdominal or pelvic pain (26.7%) while incidentally detected tumors accounted for one third of cases. The majority of cases were stage I at diagnosis (63.8%) followed by stage III disease (24.8%), and the median tumor size was 12cm. Live births occurred in 81.3% of cases, and of the remainder 72.2% were due to elective termination. Intrapartum surgery primarily took place in the second trimester (43%) with fetal conservation in 61.9% of operations. Over half of cases received chemotherapy (55.2%), approximately one third of which received it during the pregnancy (36.2%). Among the 21 cases treated with chemotherapy during pregnancy, there was no association with small for gestational age or fetal malformations. Serious adverse events occurred in 21.9% of cases, of which the most common was tumor rupture during pregnancy (10.5%). Three (2.9%) maternal death following surgery during pregnancy and five (6.4%) neonatal deaths were reported. Gestational age at tumor diagnosis (2-year overall survival rate, 1st trimester 94.6%, 2nd trimester 88.8%, and 3rd trimester 72.9%, p=0.041) type of histology (serous 88.1%, mucinous 84.6%, endometrioid 89.5%, clear cell 100%, mixed type 75.0%, and undifferentiated 30.0%, p<0.01), stage (stage I 96.9%, stage II 85.7%, stage III 56.3%, and stage IV 25.0%, p<0.01), and serious adverse events (yes versus no, 68.1% versus 92.2%, p=0.041) were significantly related to maternal overall survival in univariate analysis. In multivariate analysis, stage III/IV disease remained the independent prognostic factor associated with decreased maternal overall survival (stage III, hazard ratio 44.6, p<0.01; and stage IV, hazard ratio 399, p<0.01). In conclusion, although the majority of EOC cases during pregnancy resulted in live birth, maternal and neonatal mortality needs to be considered in the counseling and management of these pregnancies.
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Affiliation(s)
- Erin A Blake
- Department of Obstetrics and Gynecology, University of Colorado, CO, USA
| | - Michiko Kodama
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mayu Yunokawa
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Malcolm S Ross
- Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Brendan H Grubbs
- Maternal-Fetal Medicine, and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Abstract
Cancer is diagnosed approximately once per 1,000 pregnancies; most commonly due to the reproductive age of the women, these include breast, cervical, melanoma, thyroid, and Hodgkin’s lymphoma diagnoses. As a single diagnosis, breast cancer is the most common cancer diagnosed during pregnancy. Cancer is expected to complicate pregnancy more often due to the trend for women to delay child bearing to later maternal ages. Delayed first birth is itself a risk factor for breast cancer. Termination of pregnancy has not been shown to afford a survival benefit. While protecting the interests of mother and unborn fetus, breast cancer can be safely diagnosed, staged, and treated during pregnancy with good outcomes for both. Some modification of the protocols used for nonpregnant women with suspicious palpable breast masses is required. This article reviews the challenges for physicians in making the diagnosis of breast cancer during pregnancy and upon diagnosis, counseling patients about treatment options. The consequences of diagnostic investigations and cancer treatment for the exposed fetus are also addressed.
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Affiliation(s)
- Elyce Cardonick
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
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18
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Cardonick E. Specific challenges in treating breast cancer in pregnant women. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY A cancer diagnosis during pregnancy presents a challenge to practitioners and patients. Often diagnosis is delayed. There are limited prospective case series and scant long-term neonatal and maternal data on which to base treatment plans. Also, the majority of pregnancy-associated case series include women diagnosed with breast cancer up to 1 year postpartum. The later-diagnosed group has a poorer prognosis and should be evaluated separately. To avoid attributing breast masses to pregnancy-related changes, masses should be evaluated as if the patient were not pregnant. Mammography, MRI, ultrasound, mastectomy and lumpectomy, axillary dissection, sentinel lymph node biopsy and even chemotherapy during the second and third trimesters can be considered for the pregnant patient with breast cancer.
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19
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Lee NY, Lee KB, Kang YS. Pharmacokinetics, placenta, and brain uptake of paclitaxel in pregnant rats. Cancer Chemother Pharmacol 2014; 73:1041-5. [PMID: 24638863 DOI: 10.1007/s00280-014-2439-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/06/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Today, cancer incidence during pregnancy is increasing as women delay childbearing until later in life. Therefore, chemotherapy is regularly administered in pregnant women with cancer. In the present study, we evaluated the change in the pharmacokinetics and the fetus distribution of paclitaxel during pregnancy using pregnant rats. METHODS Pharmacokinetic parameters, placenta, and brain transport of [(3)H]paclitaxel were investigated in nonpregnant or pregnant rats using single intravenous injection technique. RESULTS The plasma pharmacokinetics of paclitaxel in pregnant rats was markedly different compared with nonpregnant rats. The V dss and CL of paclitaxel in pregnant rats were increased, and AUC was decreased compared with nonpregnant rats. The fetus uptake of paclitaxel is markedly lower than the placenta uptake. Paclitaxel is a substrate of P-glycoprotein (P-gp), so P-gp would affect the transport of paclitaxel to the fetus. The brain uptake of [(3)H]paclitaxtel was about twofold lower than that of nonpregnant rats. CONCLUSIONS Current findings are important when considering cancer treatment with paclitaxel during pregnancy.
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Affiliation(s)
- Na-Young Lee
- Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women's University, 52, Hyochangwon-gil, Yongsan-Gu, Seoul, 140-742, Korea
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20
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Lee NY, Lee HE, Kang YS. Identification of p-glycoprotein and transport mechanism of Paclitaxel in syncytiotrophoblast cells. Biomol Ther (Seoul) 2014; 22:68-72. [PMID: 24596624 PMCID: PMC3936425 DOI: 10.4062/biomolther.2013.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/15/2014] [Accepted: 01/16/2014] [Indexed: 01/26/2023] Open
Abstract
When chemotherapy is administered during pregnancy, it is important to consider the fetus chemotherapy exposure, because it may lead to fetal consequences. Paclitaxel has become widely used in the metastatic and adjuvant settings for woman with cancer including breast and ovarian cancer. Therefore, we attempted to clarify the transport mechanisms of paclitaxel through blood-placenta barrier using rat conditionally immortalized syncytiotrophoblast cell lines (TR-TBTs). The uptake of paclitaxel was time- and temperature-dependent. Paclitaxel was eliminated about 50% from the cells within 30 min. The uptake of paclitaxel was saturable with Km of 168 μM and 371 μM in TR-TBT 18d-1 and TR-TBT 18d-2, respectively. [3H]Paclitaxel uptake was markedly inhibited by cyclosporine and verapamil, well-known substrates of P-glycoprotein (P-gp) transporter. However, several MRP substrates and organic anions had no effect on [3H]paclitaxel uptake in TR-TBT cells. These results suggest that P-gp may be involved in paclitaxel transport at the placenta. TR-TBT cells expressed mRNA of P-gp. These findings are important for therapy of breast and ovarian cancer of pregnant women, and should be useful data in elucidating teratogenicity of paclitaxel during pregnancy.
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Affiliation(s)
- Na-Young Lee
- College of Pharmacy and Research Center for Cell Fate Control, Sookmyung Women's University, Seoul 140-742, Republic of Korea
| | - Ha-Eun Lee
- College of Pharmacy and Research Center for Cell Fate Control, Sookmyung Women's University, Seoul 140-742, Republic of Korea
| | - Young-Sook Kang
- College of Pharmacy and Research Center for Cell Fate Control, Sookmyung Women's University, Seoul 140-742, Republic of Korea
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21
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Grimm D, Woelber L, Trillsch F, Keller-v.Amsberg G, Mahner S. Clinical management of epithelial ovarian cancer during pregnancy. Eur J Cancer 2014; 50:963-71. [DOI: 10.1016/j.ejca.2013.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/06/2013] [Accepted: 12/25/2013] [Indexed: 12/27/2022]
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22
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Smith JA, Gaikwad A, Mosley S, Coffer L, Cegelski J, Alcorn JL, Ramin SM, Refuerzo JS. Utilization of an ex vivo human placental perfusion model to predict potential fetal exposure to carboplatin during pregnancy. Am J Obstet Gynecol 2014; 210:275.e1-9. [PMID: 24333234 DOI: 10.1016/j.ajog.2013.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/12/2013] [Accepted: 12/08/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine the fetal drug compartment concentrations when various concentrations of carboplatin cross the placental-trophoblastic barrier and the effect on the fetal kidneys. STUDY DESIGN An ex vivo human placenta perfusion model was utilized. Term human placentae (n = 9) were collected immediately after delivery and then reperfused with plasma concentrations achieved with carboplatin an area under the curve of 5 (1000 ng/mL), 7.5 (5000 ng/mL), or 11 (11,000 ng/mL). Antipyrine was used as a reference compound. Samples were collected over 2 hours. Placental transfer was evaluated by computation of transport fraction and clearance index. Primary cells isolated by explant culture of 16-18 week old fetal organ tissues were incubated with carboplatin for up to 48 hours with untreated cell as controls. Immunohistochemical, flow cytometry analysis, and immunoblotting were applied for the expression of apoptosis-related proteins. RESULTS Mean transport fractions for carboplatin at low, middle, and high concentrations were 0.05 ± 0.02, 0.04 ± 0.01, and 0.10 ± 0.01, respectively, with clearance indexes of 0.22 ± 0.01, 0.14 ± 0.08, and 0.50 ± 0.07, respectively. The fetal peak concentrations of carboplatin achieved were 61 ± 39 ng/mL (low), 375 ± 248 ng/mL (middle), and 2081 ± 529 ng/mL (high). Fetal kidney cells exposed to carboplatin showed a concentration-dependent increased expression of apoptosis-inducing factor and p53 apoptosis proteins and a time-dependent increase in expression Bax apoptosis protein expression. Apoptosis was confirmed at the high concentration by flow cytometry. CONCLUSION Doses of carboplatin up to an area under the curve of 7.5 were not associated with significant placental transfer, fetal exposure, or fetal toxic effects. This suggests it might not be necessary to empirically reduce carboplatin doses in pregnant women.
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23
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Gynecologic malignancy in pregnancy. Obstet Gynecol Sci 2013; 56:289-300. [PMID: 24328018 PMCID: PMC3784125 DOI: 10.5468/ogs.2013.56.5.289] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 12/20/2022] Open
Abstract
Gynecologic malignancy during pregnancy is a stressful problem. For the diagnosis and treatment of malignancy during pregnancy, a multidisciplinary approach is needed. Patients should be advised about the benefits and risk of treatment. When selecting a treatment for malignancy during pregnancy, the physiologic changes that occur with the pregnancy should be considered. Various diagnostic procedures that do not harm the fetus can be used. Laparoscopic surgery or laparotomy may be safely performed. The staging approach and treatment should be standard. Systemic chemotherapy during the first trimester should be delayed if possible. Radiation therapy should preferably start postpartum. Although delivery should be delayed preferably until after 35 weeks of gestation, termination of pregnancy may be considered when immediate treatment is required. Subsequent pregnancies do not increase the risk of malignancy recurrence.
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24
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Del Pup L, Peccatori FA, Azim HA, Michieli M, Moioli M, Giorda G, Tirelli U, Berretta M. Obstetrical, fetal and postnatal effects of gestational antiblastic chemotherapy: how to counsel cancer patients. Int J Immunopathol Pharmacol 2013; 25:33S-46S. [PMID: 23092518 DOI: 10.1177/03946320120250s203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
At least one in a thousand pregnancies is complicated by cancer and, as the maternal age at pregnancy increases, numbers are growing. If chemotherapy cannot be postponed, both doctors and patients face complex medical and ethical issues. There is a conflict between optimal maternal therapy and fetal wellbeing. Treatment during the first trimester increases the risk of congenital malformations, spontaneous abortions and fetal death. Second and third trimester exposure is less risky, but it can cause intrauterine growth retardation and low birth weight. Other effects on pregnancy after the first trimester include premature birth, stillbirth, impaired functional development, myocardial toxicity and myelosuppression. Counseling and management of these cases are difficult, because literature is mostly represented by case reports or retrospective series while randomized prospective studies or guidelines are lacking. Moreover, personal experience is often scanty due to the rarity of the condition. This article reviews the available data regarding the different aspects of systemic treatment of cancer during pregnancy to help oncologist and obstetricians in counseling their patients and treat them accordingly.
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Affiliation(s)
- L Del Pup
- Division of Gynecological Oncology, National Cancer Institute, Aviano (PN), Italy.
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25
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Zagouri F, Sergentanis TN, Chrysikos D, Dimitrakakis C, Tsigginou A, Zografos CG, Dimopoulos MA, Papadimitriou CA. Taxanes for Breast Cancer During Pregnancy: A Systematic Review. Clin Breast Cancer 2013; 13:16-23. [DOI: 10.1016/j.clbc.2012.09.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 09/23/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
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26
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Berretta M, Di Francia R, Lleshi A, De Paoli P, Li Volti G, Bearz A, Del Pup L, Tirelli U, Michieli M. Antiblastic treatment, for solid tumors, during pregnancy: a crucial decision. Int J Immunopathol Pharmacol 2013; 25:1S-19S. [PMID: 23092516 DOI: 10.1177/03946320120250s201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer is the second leading cause of death during the reproductive years complicating between 0.02 percent and 0.1 percent of pregnancies. The incidence is expected to rise with the increase in age of childbearing. The most common types of pregnancy-associated cancers are: cervical cancer, breast cancer, malignant melanoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma and ovarian cancer. The relatively rare occurrence of pregnancy-associated cancer precludes conducting large, prospective studies to examine diagnostic, management and outcome issues. The treatment of pregnancy-associated cancer is complex since it may be associated with adverse fatal effects. In pregnant patients diagnosed with cancer during the first trimester, treatment with multidrug anti-cancer chemotherapy is associated with an increased risk of congenital malformations, spontaneous abortions or fetal death, and therefore, should follow a strong recommendation for pregnancy termination. Second and third trimester exposure is not associated with teratogenic effect but increases the risk of intrauterine growth retardation and low birth weight. There are no sufficient data regarding the teratogenicity of most cytotoxic drugs. Almost all chemotherapeutic agents were found to be teratogenic in animals and for some drugs only experimental data exist. Moreover, no pharmacokinetic studies have been conducted in pregnant women receiving chemotherapy in order to understand whether pregnant women should be treated with different doses of chemotherapy. This article reviews the available data regarding the different aspects of the treatment of cancer during pregnancy.
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Affiliation(s)
- M Berretta
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy.
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Cardonick E, Bhat A, Gilmandyar D, Somer R. Maternal and fetal outcomes of taxane chemotherapy in breast and ovarian cancer during pregnancy: case series and review of the literature. Ann Oncol 2012; 23:3016-3023. [PMID: 22875836 DOI: 10.1093/annonc/mds170] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the use of taxane chemotherapy during pregnancy and compare maternal and neonatal outcomes with those in women who did not receive taxanes during pregnancy, and review current existing data. STUDY DESIGN This is a retrospective cohort study in which women were identified from the Cancer and Pregnancy Registry at Robert Wood Johnson Medical Center. A retrospective chart analysis and an independent t-test were carried out comparing patient outcomes. A literature search in Ovid, Medline and PubMed was then carried out using the terms 'breast or ovarian cancer', 'pregnancy', 'paclitaxel', 'docetaxel', 'taxanes' and 'chemotherapy'. RESULTS Twelve of 129 women with breast cancer were exposed to taxanes during pregnancy. Three of nine women with ovarian cancer received taxane-based treatment during pregnancy. Birth weight, gestational age at delivery, rate of growth restriction, congenital anomalies and incidence of maternal and neonatal neutropenia were not statistically different between the two groups. CONCLUSIONS Taxane-based chemotherapy does not appear to increase the risk of fetal or maternal complications when compared with conventional chemotherapy in the small cohort of women in our Registry.
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Affiliation(s)
- E Cardonick
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cooper Medical School at Rowan University, Camden.
| | - A Bhat
- Division of Hematology and Medical Oncology, Department of Medicine, Cooper Medical School at Rowan University, Camden
| | - D Gilmandyar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, USA
| | - R Somer
- Division of Hematology and Medical Oncology, Department of Medicine, Cooper Medical School at Rowan University, Camden
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Gui T, Cao D, Shen K, Yang J, Fu C, Lang J, Liu X. Management and outcome of ovarian malignancy complicating pregnancy: an analysis of 41 cases and review of the literature. Clin Transl Oncol 2012; 15:548-54. [PMID: 23150218 DOI: 10.1007/s12094-012-0965-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/22/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study are to summarize our experience of managing ovarian malignancy complicating pregnancy, to discuss the maternal and fetal outcomes, and to review the literature concerned. METHODS Forty-one patients with ovarian malignancies complicating pregnancy at Peking Union Medical College Hospital between 1990 and 2012 were retrospectively reviewed. RESULTS Of the 41 patients, malignancies included epithelial ovarian cancers (13/41, 31.7 %), epithelial borderline ovarian tumors (12/41, 29.3 %), ovarian malignant germ cell tumors (10/41, 24.4 %), sexcord stromal tumors (3/41, 7.3 %), metastatic ovarian tumors (2/41, 4.9 %), and primary ovarian choriocarcinoma (1/41, 2.4 %). The median overall survival was 30 months (range 3-165), with an overall mortality rate of 24.4 %. The pregnancy outcomes included termination in the first trimester (8/41, 19.5 %), full-term vaginal delivery (7/41, 17.0 %), full-term cesarean section (17/41, 41.5 %), and therapeutic cesarean section for premature birth (9/41, 22.0 %). One preterm newborn died, and the remaining 32 survived in healthy status. All patients underwent surgery, and those who deliberately delayed radical surgery had gloomy prognosis. Two patients received chemotherapy during pregnancy, and 24 patients started chemotherapy after pregnancy termination. CONCLUSIONS Management priority should be given to the malignancy of ovarian tumors at any stage of pregnancy. Surgical intervention is the main treatment modality, and delaying of radical surgery is not recommended for patients with suspicion of high malignancy. Early diagnosis and appropriate treatment could offer satisfactory prognosis.
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Affiliation(s)
- T Gui
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Autio K, Rassnick KM, Bedford-Guaus SJ. Chemotherapy during pregnancy: a review of the literature. Vet Comp Oncol 2012; 5:61-75. [PMID: 19754790 DOI: 10.1111/j.1476-5829.2006.00119.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although diagnosing cancer during pregnancy is uncommon in veterinary medicine, when it occurs, chemotherapy may represent a reasonable treatment option. A major consideration is that physiological changes associated with pregnancy affect drug pharmacokinetics and complicate correct dosing of chemotherapy agents. Additionally, most antineoplastic drugs are able to cross the placenta thus adversely affecting the foetus. However, favourable outcomes have been observed in human beings when chemotherapy has been administered after organogenesis. Conversely, chemotherapy should be avoided during the early embryonic and organogenesis periods as it might lead to foetal death and/or major malformations.
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Affiliation(s)
- K Autio
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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Zagouri F, Sergentanis TN, Chrysikos D, Filipits M, Bartsch R. Taxanes for ovarian cancer during pregnancy: a systematic review. Oncology 2012; 83:234-8. [PMID: 22907101 DOI: 10.1159/000341351] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/04/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Ovarian cancer in pregnancy is uncommon; however, this diagnosis adds complexity to cancer treatment recommendations. This is the first systematic review to synthesize all available data and evaluate the efficacy and safety of taxanes during pregnancy in ovarian cancer. METHODS This systematic review was performed in accordance with PRISMA guidelines. All studies that examined the efficacy and safety of taxanes administered during pregnancy in ovarian cancer, regardless of sample size, were considered eligible. RESULTS Overall, 8 articles (11 pregnancies, 12 newborns) were retrieved for paclitaxel and 1 for docetaxel (1 pregnancy, 1 newborn). In 92.31% of cases a healthy child was born, with a median follow-up of 20 months. The mean weight of the babies at delivery was 2,381 g. One study providing follow-up until the 11th year of age reported a case of attention deficit disorder. In 6 out of 8 case reports providing survival data, the mother was alive and disease free at the end of follow-up (ranging from 9.75 to 45 months). CONCLUSION Taxanes may play a significant role in the treatment of ovarian cancer patients during the 2nd and 3rd trimesters. Before that, the risk of abortion or congenital anomalies is increased.
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Affiliation(s)
- Flora Zagouri
- Comprehensive Cancer Center Vienna, Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria.
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Selig BP, Furr JR, Huey RW, Moran C, Alluri VN, Medders GR, Mumm CD, Hallford HG, Mulvihill JJ. Cancer chemotherapeutic agents as human teratogens. ACTA ACUST UNITED AC 2012; 94:626-50. [DOI: 10.1002/bdra.23063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/29/2012] [Accepted: 07/04/2012] [Indexed: 12/11/2022]
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Abstract
Cervical and ovarian cancers are the most common gynaecological cancers diagnosed during pregnancy. In early-stage cervical cancer during the first and at the beginning of the second trimester, the two main considerations for management of the patient are the tumour size (and stage) and nodal staging. MRI and laparoscopic lymphadenectomy are useful for clinicians planning a potentially conservative approach. The management of patients with locally advanced cervical disease is controversial and should be discussed on a case-by-case basis according to the tumour size, radiological findings, the term of pregnancy, and the patient's wishes. Different histological types of malignant ovarian diseases arise during pregnancy and their management depends on the diagnosis (histological subtypes, tumour differentiation, and nodal status), the tumour stage, and the trimester of the pregnancy. In patients with peritoneal spread or high-risk early-stage disease, neoadjuvant chemotherapy with pregnancy preservation could be appropriate.
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Affiliation(s)
- Philippe Morice
- Department of Gynecologic Surgery, Institut Gustave Roussy, Villejuif, France.
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Gottschalk I, Berg C, Harbeck N, Stressig R, Kozlowski P. Fetal Renal Insufficiency Following Trastuzumab Treatment for Breast Cancer in Pregnancy: Case Report und Review of the Current Literature. ACTA ACUST UNITED AC 2011; 6:475-478. [PMID: 22419904 DOI: 10.1159/000335202] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Some drugs are known for their fetal nephrotoxicity and should be avoided during pregnancy. We report on a pregnant woman suffering from breast cancer who received a weekly neoadjuvant trastuzumab (Herceptin(®)) therapy from 15 weeks of gestation onward, in addition to a 3-weekly carboplatin/docetaxel chemotherapy. Fetal renal insufficiency with anhydramnios and missing visualization of the fetal bladder developed at 21 weeks. After discontinuation of trastuzumab and repeated instillation of amniotic fluid, the amount of amniotic fluid remained stable after 24 weeks of gestation. After caesarean section at 34 weeks because of fetal growth restriction, the renal function of the neonate was normal postnatally. In accordance with the current literature, our case shows a reversible adverse effect of trastuzumab on the fetal renal function and confirms the current recommendation that trastuzumab in pregnancy should be avoided. In pregnancies exposed to trastuzumab, treatment should be discontinued and the fetus should be closely monitored, with particular attention to the amniotic fluid and the fetal bladder volume, as these reflect fetal renal function.
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Affiliation(s)
- Ingo Gottschalk
- Pränatalmedizin und Gynäkologische Sonographie, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität zu Köln, Düsseldorf, Germany
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Nulman I, Edell H. Paediatric outcomes following in utero exposure to the diagnosis and treatment of maternal malignancy. Eur J Cancer 2011; 47 Suppl 3:S217-29. [DOI: 10.1016/s0959-8049(11)70168-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hoellen F, Reibke R, Hornemann K, Thill M, Luedders DW, Kelling K, Hornemann A, Bohlmann MK. Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies. Arch Gynecol Obstet 2011; 285:195-205. [PMID: 21858441 DOI: 10.1007/s00404-011-2058-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/02/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer in pregnancy is a rare circumstance. However, the coincidence of pregnancy and malignancy is supposed to increase due to a general tendency of postponing childbearing to older age. To date, clinical guidelines are scarce and experience regarding therapeutic management is limited to case reports. METHODS This review focuses on general diagnostic and therapeutic principles including systemic therapy for malignancies in pregnancy. RESULTS In part I, we report on diagnosis and therapy of gynecological tumors. CONCLUSION The diagnosis of gestational cancer faces both oncologist and obstetrician to the dilemma of applying appropriate diagnostic techniques and adequate local and systemic therapy to an expectant mother without harming the fetus.
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Affiliation(s)
- Friederike Hoellen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Li J, Wang LJ, Zhang BZ, Peng YP, Lin ZQ. Neoadjuvant chemotherapy with paclitaxel plus platinum for invasive cervical cancer in pregnancy: two case report and literature review. Arch Gynecol Obstet 2011; 284:779-83. [DOI: 10.1007/s00404-011-1943-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 06/01/2011] [Indexed: 11/30/2022]
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38
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Breast cancer in pregnancy. Eur Surg 2011. [DOI: 10.1007/s10353-011-0595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Serkies K, Węgrzynowicz E, Jassem J. Paclitaxel and cisplatin chemotherapy for ovarian cancer during pregnancy: case report and review of the literature. Arch Gynecol Obstet 2011; 283 Suppl 1:97-100. [PMID: 21369726 PMCID: PMC3070876 DOI: 10.1007/s00404-011-1855-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 02/01/2011] [Indexed: 11/25/2022]
Abstract
The safety of chemotherapy during pregnancy is debatable. We present a case of advanced ovarian cancer, diagnosed at week 28 of gestational age, treated with 2 cycles of paclitaxel/cisplatin (TC) chemotherapy during pregnancy, with no serious toxicity. At week 34, the patient underwent a caesarean section and delivered a healthy girl. Four additional cycles of TC were administered. Three months after completing chemotherapy, the patient developed abdominal progression and subsequently a huge metastatic cystic mass in the brain. Despite subsequent therapies, the patient died of progressive disease 35 months after the diagnosis. The infant had normal growth and development by 73 months of her age. This is another reported case of ovarian cancer diagnosed during the second trimester of the pregnancy treated with TC chemotherapy without apparent teratogenic effect.
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Affiliation(s)
- Krystyna Serkies
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Dębinki St., 80-211, Gdańsk, Poland.
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Treatment of recurrent vulvar Paget disease with imiquimod cream: a case report and review of the literature. Arch Gynecol Obstet 2010; 283:97-101. [PMID: 20803209 DOI: 10.1007/s00404-010-1653-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Extra-mammary Paget disease is one of the rare neoplastic conditions of the skin. The most common site of involvement is the vulva and presents itself with erythematous plaques. Surgery is the most important treatment option. In the recent years, there are publications of the topical use of imiquimod cream in extra-mammary cutaneous Paget disease. We report the case of a woman with recurrent vulvar Paget disease, who underwent successful treatment with imiquimod cream. We also review the reports of other patients with vulvar Paget disease who were treated with topical imiquimod cream. CASE REPORT A 65-year-old woman presented to the Oncology Outpatient Clinic with an itchy lesion in her vulva for 2 years. In the gynecologic examination, a hyperkeratotic erythematous lesion was found starting from the right labium to involve clitoris, with a size of 4 × 3 cm. Pathology result was reported as Paget disease. She was operated and wide vulvar excision was performed with a safety margin of 2 cm. Then recurrence two times occurred. Because she refused surgery, imiquimod cream 5% was applied for treatment. CONCLUSION Imiquimod cream is an effective and safe therapeutic agent for both primary and recurring vulvar Paget disease.
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Kwon YS, Mok JE, Lim KT, Lee IH, Kim TJ, Lee KH, Shim JU. Ovarian cancer during pregnancy: clinical and pregnancy outcome. J Korean Med Sci 2010; 25:230-4. [PMID: 20119575 PMCID: PMC2811289 DOI: 10.3346/jkms.2010.25.2.230] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 04/24/2009] [Indexed: 11/20/2022] Open
Abstract
The aim of this study is to evaluate the clinical feature and pregnancy outcome in patients with ovarian cancer diagnosed during pregnancy. We retrospectively analyzed the medical records of 27 patients diagnosed with ovarian cancer during pregnancy at Cheil General Hospital & Women's Healthcare Center from January 1996 to December 2006. Mean age of the patients was 29.1 yr (range 23-40), and a mean follow-up period was 57 months (range 7-112 months). Of 27 patients, 15 (55.5%) had borderline malignancies, 7 (25.9%) had epithelial malignancies and 5 (18.6%) had germ cell tumors. A total of 26 patients received a conservative surgery preserving pregnancy. The mean time for surgical intervention during pregnancy was 20 weeks of gestational age. Of the 27 patients, 26 had full term delivery of a healthy baby without any congenital malformation. Only one patient with epithelial ovarian cancer had a relapse at 19 months after the first conservative operation with adjuvant chemotherapy. There were few data for managing patients with ovarian cancer diagnosed during pregnancy. This study results could help establish a guideline for management of ovarian malignancy complicating pregnancy.
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Affiliation(s)
- Yong-Soon Kwon
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Jung-Eun Mok
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Kyung-Taek Lim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - In-Ho Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Tae-Jin Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Ki-Heon Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
| | - Jae-Uk Shim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
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Amant F, Brepoels L, Halaska MJ, Gziri MM, Van Calsteren K. Gynaecologic cancer complicating pregnancy: An overview. Best Pract Res Clin Obstet Gynaecol 2010; 24:61-79. [DOI: 10.1016/j.bpobgyn.2009.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 08/05/2009] [Indexed: 11/26/2022]
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Vivas-Mejia P, Benito JM, Fernandez A, Han HD, Mangala L, Rodriguez-Aguayo C, Chavez-Reyes A, Lin YG, Carey MS, Nick AM, Stone RL, Kim HS, Claret FX, Bornmann W, Hennessy BTJ, Sanguino A, Peng Z, Sood AK, Lopez-Berestein G. c-Jun-NH2-kinase-1 inhibition leads to antitumor activity in ovarian cancer. Clin Cancer Res 2009; 16:184-94. [PMID: 20028751 DOI: 10.1158/1078-0432.ccr-09-1180] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To show the functional, clinical, and biological significance of c-Jun-NH(2)-kinase (JNK)-1 in ovarian carcinoma. EXPERIMENTAL DESIGN Analysis of the impact of JNK on 116 epithelial ovarian cancers was conducted. The role of JNK in vitro and in experimental models of ovarian cancer was assessed. We studied the role of N-5-[4-(4-methyl piperazine methyl)-benzoylamido]-2-methylphenyl-4-[3-(4-methyl)-pyridyl]-2-pyrimidine amine (WBZ_4), a novel JNK inhibitor redesigned from imatinib based on targeting wrapping defects, in cell lines and in experimental models of ovarian cancer. RESULTS We found a significant association of pJNK with progression-free survival in the 116 epithelial ovarian cancers obtained at primary debulking therapy. WBZ_4 led to cell growth inhibition and increased apoptosis in a dose-dependent fashion in four ovarian cancer cell lines. In vivo, whereas imatinib had no effect on tumor growth, WBZ_4 inhibited tumor growth in orthotopic murine models of ovarian cancer. The antitumor effect was further increased in combination with docetaxel. Silencing of JNK-1 with systemically administered siRNA led to significantly reduced tumor weights compared with nonsilencing siRNA controls, indicating that indeed the antitumor effects observed were due to JNK-1 inhibition. CONCLUSIONS These studies identify JNK-1 as an attractive therapeutic target in ovarian carcinoma and that the redesigned WBZ_4 compound should be considered for further clinical development.
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Affiliation(s)
- Pablo Vivas-Mejia
- Department of Experimental Therapeutics, Center for RNAi and non-coding-RNA, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Azim HA, Peccatori FA, Pavlidis N. Treatment of the pregnant mother with cancer: a systematic review on the use of cytotoxic, endocrine, targeted agents and immunotherapy during pregnancy. Part I: Solid tumors. Cancer Treat Rev 2009; 36:101-9. [PMID: 20015593 DOI: 10.1016/j.ctrv.2009.11.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 11/05/2009] [Accepted: 11/15/2009] [Indexed: 01/14/2023]
Abstract
The association of cancer and pregnancy is increasingly encountered nowadays in clinical practice. Due to the relative rarity of the situation, it lacks a systematized approach. Different systemic therapies are used in managing cancer with uncertainty regarding the potential hazards they could pose on the pregnancy and/or the fetus. We have performed a systematic review of literature to identify all reports addressing cancer patients who were exposed to any of the known systemic therapies during the course of the pregnancy. The results were discussed in two parts; part I addresses pregnant patients with solid tumors while part I for those with hematological malignancies. In part I, we identified different solid tumors diagnosed and treated during the course of pregnancy. Breast cancer was the most commonly treated followed by ovarian cancer. Other tumors were treated as well including lung cancer, cervical cancer, sarcoma and melanomas. It is important to acknowledge the intent of therapy (palliative vs. curative) and the patients has to be properly counseled to reach an informed decision. We aim to provide a more robust consensus on how to approach these cases and provide a higher degree of evidence to support the safety of applying certain management strategies over the other.
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Affiliation(s)
- Hatem A Azim
- Department of Medical Oncology, National Cancer Institute, Cairo University, 55 Abdel Monem Riad Street, Mohandeseen, Cairo, Egypt.
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Marret H, Lhommé C, Lécuru F, Canis M, Léveque J, Golfier F, Morice P. [French recommendations for ovarian cancer management during pregnancy]. ACTA ACUST UNITED AC 2009; 37:752-63. [PMID: 19709917 DOI: 10.1016/j.gyobfe.2009.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evaluation of the fetus using prenatal ultrasound has resulted in increased detection of asymptomatic adnexal masses during pregnancy. Such masses are rarely malignant (1/10 000 to 1/50 000 pregnancies), but the possibility of borderline or cancer must be considered. It is a common assumption by both patients and physicians that if an ovarian cancer is diagnosed during pregnancy, treatment necessitates sacrificing the well-being of the fetus. However, in most cases, it is possible to offer appropriate treatment to the mother without placing the fetus at serious risk. The care of a pregnant woman with cancer involves evaluation of sometimes competing maternal and fetal risks and benefits. These recommendation approaches attempt to balance these risks and benefits; however, they should be considered advisory and should not replace specific interdisciplinary consultation with specialists in maternal-fetal medicine, gynecologic oncology, and pediatrics, as well as imaging and pathology, as needed. Second level ultrasound including Doppler is needed. MRI is not often necessary, and CA 125 is of low contribution. We suggest surgery be performed after 15 SA for ovarian masses which (1) persist into the second trimester, (2) are greater than 5 to 10 cm in diameter, or (3) have solid or mixed solid and cystic ultrasound characteristics. During antepartum surgical staging and debulking, homolateral salpingo-oophorectomy and peritoneal cytology and exploration are necessary. Women found to have advanced stage epithelial ovarian cancer should consider having completion of the debulking of the reproductive organs at the conclusion of the pregnancy. If chemotherapy is indicated, we recommend delaying administration, if possible, after the delivery or at least after 20 SA in order to minimize the potential fetal toxicity.
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Affiliation(s)
- H Marret
- Service de gynécologie, hôpital Bretonneau, centre hospitalo-universitaire de Tours, 37044 Tours cedex 1, France.
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Amant F, Van Calsteren K, Halaska MJ, Beijnen J, Lagae L, Hanssens M, Heyns L, Lannoo L, Ottevanger NP, Vanden Bogaert W, Ungar L, Vergote I, du Bois A. Gynecologic Cancers in Pregnancy. Int J Gynecol Cancer 2009; 19 Suppl 1:S1-12. [DOI: 10.1111/igc.0b013e3181a1d0ec] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Morris PG, King F, Kennedy MJ. Cytotoxic chemotherapy for pregnancy-associated breast cancer: single institution case series. J Oncol Pharm Pract 2009; 15:241-7. [DOI: 10.1177/1078155209103096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Pregnancy-associated (PA) breast cancer is a rare disease state that poses unique management challenges, specifically controlling the cancer and maximizing the survival of the expectant mother balanced with the health and safety of the developing fetus. As more women delay pregnancy into their 30s and 40s it is expected that this may become a more important clinical problem in the future. Existing data on PA-breast cancer comes from case series using older chemotherapy drugs. A review of practice was carried out to assess current experience with PA-breast cancer, particularly relating to current cytotoxic drugs and targeted agents. Methods. The St James’s Hospital breast cancer registry, a prospectively maintained database, was used to identify cases of PA-breast cancer over a 6.5-year period and a chart review carried out. Chemotherapy administered during pregnancy, breast cancer specific outcomes, and fetal outcomes were assessed. Results. Five patients were identified with PA-breast cancer; median age 34 years (range 28—35). The median gestation at presentation was 18 weeks (range 14—29). Four women received chemotherapy during pregnancy; three received doxorubicin and cyclophosphamide (AC) and one paclitaxel. These agents were generally well tolerated. At median gestation of 36 weeks (range 35—40 weeks) four elective caesareans and one spontaneous delivery occurred. There were no fetal abnormalities. Conclusions. Common cytotoxics can safely be delivered in pregnancy. Further research on newer therapies such as trastuzumab is needed.
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Affiliation(s)
- Patrick G Morris
- Academic Unit of Clinical and Molecular Oncology, St James's Hospital and Trinity College Dublin, Ireland
| | - Fionnuala King
- Academic Unit of Clinical and Molecular Oncology, St James's Hospital and Trinity College Dublin, Ireland
| | - M John Kennedy
- Academic Unit of Clinical and Molecular Oncology, St James's Hospital and Trinity College Dublin, Ireland,
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Affiliation(s)
- J Palmer
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, UK.
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49
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Doi D, Boh Y, Konishi H, Asakura H, Takeshita T. Combined chemotherapy with paclitaxel and carboplatin for mucinous cystadenocarcinoma of the ovary during pregnancy. Arch Gynecol Obstet 2009; 280:633-6. [DOI: 10.1007/s00404-009-0950-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 01/13/2009] [Indexed: 10/21/2022]
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Cheung EJ, Wagner H, Botti JJ, Fedok F, Goldenberg D. Advanced Oral Tongue Cancer in a 22-Year-Old Pregnant Woman. Ann Otol Rhinol Laryngol 2009; 118:21-6. [DOI: 10.1177/000348940911800104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Oral squamous cell carcinoma generally occurs in older men and is associated mostly with tobacco and alcohol as the primary risk factors. The incidence of oral squamous cell carcinoma in younger patients has increased. We report a case of a young woman, 25 weeks pregnant, who presented with stage IV carcinoma of the oral tongue. Methods: The following is a case presentation and literature review. Results: The patient presented with T4 N3 M0 oral tongue cancer. A team consisting of a head and neck surgeon, a radiation oncologist, a medical oncologist, and a maternal-fetal medicine specialist was assembled. The patient initially refused surgery. Chemotherapy was initiated until 32 weeks' gestation. After an infant boy was delivered via cesarean section, the patient began concurrent irradiation and chemotherapy, which induced complete regression of the primary tongue neoplasm with a partial response of the neck nodes. The patient underwent bilateral neck dissection followed by hemiglossectomy for recurrence. Conclusions: Management of advanced oral carcinoma in pregnancy presents a unique set of challenges. Few studies have described chemotherapy and radiotherapy during pregnancy, and long-term results are needed. Care must be taken to balance appropriate and adequate treatment of disease and to ensure the safety of the patient and the fetus.
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