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Maeda T, Nishimura M, Sogawa E, Kaji T, Irahara M, Iwasa T. Pathological examination of a placenta leading to the diagnosis of endometrial carcinoma: A case report. Mol Clin Oncol 2021; 16:24. [PMID: 34909202 PMCID: PMC8655730 DOI: 10.3892/mco.2021.2457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/04/2021] [Indexed: 11/15/2022] Open
Abstract
Although endometrial cancer is extremely rare during pregnancy, the placental metastasis of endometrial cancer is even rarer. The current study presents a case of endometrial carcinoma that was diagnosed through the pathological examination of the placenta. A 35-year-old primipara woman who underwent frozen-thawed embryo transfer at the Keiai Ladies Clinic in Tokushima prefecture (Japan) received regular prenatal check-ups. She was transferred to Tokushima University Hospital for perinatal management due to the preterm premature rupture of membranes at 21 weeks and 6 days gestation. The administration of antibiotics and tocolytic agents was continued; however, labor pain occurred at 23 weeks and 3 days gestation, and a female fetus weighing 524 g was delivered vaginally. The placenta weighed 262 g and had no macroscopic abnormalities. It was submitted for pathological examination, which revealed metastatic adenocarcinoma (clear cell carcinoma suspected). The patient was subsequently diagnosed with endometrial cancer (stage I suspected), and underwent abdominal total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy and pelvic lymph node dissection. The final diagnosis was stage IA endometrial cancer (endometrioid carcinoma, G2). At 1 year after surgery, there was no evidence of disease. The present case highlights the importance of considering the emergence of endometrial cancer during pregnancy.
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Affiliation(s)
- Takaaki Maeda
- Department of Obstetrics and Gynecology, Tokushima University Hospital, Tokushima 770-8503, Japan
| | - Masato Nishimura
- Department of Obstetrics and Gynecology, Tokushima University Hospital, Tokushima 770-8503, Japan
| | - Eishi Sogawa
- Department of Obstetrics and Gynecology, Tokushima University Hospital, Tokushima 770-8503, Japan
| | - Takashi Kaji
- Department of Obstetrics and Gynecology, Tokushima University Hospital, Tokushima 770-8503, Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Tokushima University Hospital, Tokushima 770-8503, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Tokushima University Hospital, Tokushima 770-8503, Japan
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Tafesse TB, Bule MH, Khan F, Abdollahi M, Amini M. Developing Novel Anticancer Drugs for Targeted Populations: An Update. Curr Pharm Des 2021; 27:250-262. [PMID: 33234093 DOI: 10.2174/1381612826666201124111748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Due to higher failure rates, lengthy time and high cost of the traditional de novo drug discovery and development process, the rate of opportunity to get new, safe and efficacious drugs for the targeted population, including pediatric patients with cancer, becomes sluggish. OBJECTIVES This paper discusses the development of novel anticancer drugs focusing on the identification and selection of targeted anticancer drug development for the targeted population. METHODS Information presented in this review was obtained from different databases, including PUBMED, SCOPUS, Web of Science, and EMBASE. Various keywords were used as search terms. RESULTS The pharmaceutical companies currently are executing drug repurposing as an alternative means to accelerate the drug development process that reduces the risk of failure, time and cost, which take 3-12 years with almost 25% overall probability of success as compared to de novo drug discovery and development process (10- 17 years) which has less than 10% probability of success. An alternative strategy to the traditional de novo drug discovery and development process, called drug repurposing, is also presented. CONCLUSION Therefore, to continue with the progress of developing novel anticancer drugs for the targeted population, identification and selection of target to specific disease type is important. Considering the aspects of the age of the patient and the disease stages such as each cancer types are different when we study the disease at a molecular level. Drug repurposing technique becomes an influential alternative strategy to discover and develop novel anticancer drug candidates.
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Affiliation(s)
- Tadesse B Tafesse
- Department of Medicinal Chemistry, School of Pharmacy, Drug Design and Development Research Center and The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammed H Bule
- Department of Medicinal Chemistry, School of Pharmacy, Drug Design and Development Research Center and The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazlullah Khan
- Department of Allied Health Sciences, Bashir Institute of Health Sciences, Bhara Kahu Islamabad, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), and Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohsen Amini
- Department of Medicinal Chemistry, School of Pharmacy, Drug Design and Development Research Center and The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Abel MK, Liao CI, Chan C, Lee D, Rohatgi A, Darcy KM, Tian C, Mann AK, Maxwell GL, Kapp DS, Chan JK. Racial disparities in high-risk uterine cancer histologic subtypes: A United States Cancer Statistics study. Gynecol Oncol 2021; 161:470-476. [PMID: 33722415 DOI: 10.1016/j.ygyno.2021.02.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Black women with uterine cancer on average have worse survival outcomes compared to White women, in part due to higher rates of aggressive, non-endometrioid subtypes. However, analyses of incidence trends by specific high-risk subtypes are lacking, including those with hysterectomy and active pregnancy correction. The objective of our study was to evaluate racial disparities in age-adjusted incidence of non-endometrioid uterine cancer in 720,984 patients. METHODS Data were obtained from United States Cancer Statistics using SEER*Stat. We used the Behavioral Risk Factor Surveillance System to correct for hysterectomy and active pregnancy. Age-adjusted, corrected incidence of uterine cancer from 2001 to 2016 and annual percent change (APC) were calculated using Joinpoint regression. RESULTS Of 720,984 patients, 560,131 (77.7%) were White, 72,328 (10.0%) were Black, 56,239 (7.8%) were Hispanic, and 22,963 (3.2%) were Asian/Pacific Islander. Age-adjusted incidence of uterine cancer increased from 40.8 (per 100,000) in 2001 to 42.9 in 2016 (APC = 0.5, p < 0.001). Black women had the highest overall incidence at 49.5 (APC = 2.3, p < 0.001). The incidence of non-endometrioid subtypes was higher in Black compared to White women, with the most pronounced differences seen in serous carcinoma (9.1 vs. 3.0), carcinosarcoma (6.1 vs. 1.8), and leiomyosarcoma (1.3 vs. 0.6). In particular, Black women aged 70-74 with serous carcinoma had the highest incidence (61.3) and the highest APC (7.3, p < 0.001). CONCLUSIONS Black women have a two to four-fold higher incidence of high-risk uterine cancer subtypes, particularly serous carcinoma, carcinosarcoma, and leiomyosarcoma, compared to White women after correcting for hysterectomy and active pregnancy.
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Affiliation(s)
- Mary Kathryn Abel
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Cheng-I Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chloe Chan
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Danny Lee
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Atharva Rohatgi
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Amandeep K Mann
- Division of Gynecologic Oncology, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - George L Maxwell
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - John K Chan
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA.
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de Oliveira VA, Pereira IC, Nogueira TR, Martins JA, Péres-Rodrigues G, de Jesus e Silva de Almendra B, Silva VC, Júnior DD, Leal FL, de Castro e Sousa JM, da Silva FC, de Carvalho Melo Cavalcanti AA, de Azevedo Paiva A. The Role of Vitamin E in Breast Cancer Treatment and Prevention: Current Perspectives. CURRENT NUTRITION & FOOD SCIENCE 2021. [DOI: 10.2174/1573401316999200614164711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Regarding the multifactorial etiology of breast cancer, food choices, as well
as dietary intake, are the main modified factors in cancer prevention. In this sense, understanding
molecular pathways involved in breast cancer proliferation can help determine the mechanisms of
action of organic compounds such as antioxidant vitamins that are known to protect against cancer.
Objective:
Assess the mechanism of action of vitamin E in breast cancer modulation, with emphasis
on important markers of tumor development.
Methods:
It is a systematic review carried out in PubMed and Web of Science databases, from the
last 5 years, in Portuguese, English and Spanish. The following terms were selected according to The
Medical Subject Headings (MeSH): “breast cancer” OR “breast neoplasms”, “tocopherol” OR
“tocotrienols” OR “vitamin E”, as equated terms.
Results:
A total of 595 articles were found and 25 were selected according to inclusion criteria.
Vitamin E has been related to suppression/overexpression of important tumorigenic pathways,
mainly associated with proliferation, energy metabolism, chemosensitivity and invasion/metastasis.
Clinical studies of vitamin E supplementation are needed to assess the dose/response effect on breast
cancer patients.
Conclusion:
The safety of vitamin E supplementation is still controversial due to current studies design
available. However, when vitamin E is supplemented, the dose and therapeutic regimen must be
carefully decided, including the route of administration and breast cancer subtypes to enhance
desired effects and minimize unwanted side effects.
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Affiliation(s)
- Victor A. de Oliveira
- Department of Nutrition, Federal University of Piaui, UFPI, Piaui State, Teresina, Brazil
| | - Irislene C. Pereira
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Piaui, UFPI, Piaui State, Teresina, Brazil
| | - Thaís R. Nogueira
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Piaui, UFPI, Piaui State, Teresina, Brazil
| | - Jorddam A. Martins
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Piaui, UFPI, Piaui State, Teresina, Brazil
| | | | | | - Vladimir C. Silva
- Department of Biochemistry and Pharmacology, Federal University of Piaui, UFPI, Piaui State, Teresina, Brazil
| | - Dalton D. Júnior
- Department of Biochemistry and Pharmacology, Federal University of Piaui, UFPI, Piaui State, Teresina, Brazil
| | - Francisco L.T. Leal
- Department of Biophysics and Physiology, Federal University of Piaui, UFPI, Piaui State, Teresina, Brazil
| | - Joáo M. de Castro e Sousa
- Department of Biochemistry and Pharmacology, Federal University of Piaui, UFPI, Piaui State, Teresina, Brazil
| | - Felipe C.C. da Silva
- Department of Biology, Federal University of Piaui, UFPI, Piaui State, Picos, Brazil
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Ota E, Nomura H, Omatsu K, Takazawa Y, Takeshima N. A case of endometrial carcinoma progressed during pregnancy resulting in fetal death. Int Cancer Conf J 2020; 9:159-161. [PMID: 32582523 DOI: 10.1007/s13691-020-00417-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022] Open
Abstract
Most endometrial carcinomas (ECs) occurring during pregnancy are diagnosed in the first trimester. During the gestation period, progesterone level, which has a protective effect on the endometrium, is found to increase. In EC cases, administering high-dose progesterone is a therapeutic strategy because this hormone can considerably shrink tumors. Herein, the case of a woman in whom EC progressed during pregnancy is reported. Before pregnancy, she was diagnosed with atypical polypoid adenomyoma based on a blind office biopsy. She spontaneously conceived 2 months later, although she was suggested to undergo dilatation and curettage under general anesthesia to confirm the diagnosis. Subsequently, fetal death occurred at 26 weeks. A vaginal delivery was deemed impossible due to vaginal metastasis of EC; thus, cesarean section was performed. Computed tomography revealed multiple lung, pelvic, and inguinal lymph node metastases. Additional biopsy demonstrated poorly differentiated endometrioid carcinoma. She underwent systemic chemotherapy. However, eventually, the disease progressed, resulting in death 11 months after the cesarean section. In the present case, grade 3 EC may have existed before pregnancy, and this condition could have been diagnosed if hysteroscopic resection or total curettage under general anesthesia was performed. Grade 1 tumor may have been eliminated by the high progesterone level maintained during pregnancy, and thus, only grade 3 tumor progressed. Women who wish to preserve their fertility should undergo precise whole endometrial examination. If not, the fetus and mother may consequently experience an eventful clinical course.
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Affiliation(s)
- Emi Ota
- Department of Gynecology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Koto-ku, Ariake, Tokyo, 135-8550 Japan
| | - Hidetaka Nomura
- Department of Gynecology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Koto-ku, Ariake, Tokyo, 135-8550 Japan
| | - Kohei Omatsu
- Department of Gynecology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Koto-ku, Ariake, Tokyo, 135-8550 Japan
| | | | - Nobuhiro Takeshima
- Department of Gynecology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Koto-ku, Ariake, Tokyo, 135-8550 Japan
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Danet C, Araujo M, Bos-Thompson MA, Portolan G, Gautier S, Vanlemmens L, Bonenfant S, Jonville-Béra AP, Cottin J, Vial T, Bavoux F, Montastruc JL, Damase-Michel C, Benevent J, Bourgeois-Mondon I, Lacroix I. Pregnancy outcomes in women exposed to cancer chemotherapy. Pharmacoepidemiol Drug Saf 2018; 27:1302-1308. [PMID: 30379378 DOI: 10.1002/pds.4689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/06/2018] [Accepted: 09/27/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE There is little data on the effects of cancer chemotherapy in pregnant women. The objective of this study was to describe pregnancy outcomes of women exposed to cancer chemotherapy, recorded in the French Terappel database. METHODS We performed a descriptive, prospective study of the pregnancies of women exposed to cancer chemotherapy recorded in Terappel between June 1984 and December 2016. Terappel is a French database that has recorded questions of health professionals and/or individuals at the Regional Pharmacovigilance Centres about drugs and pregnancy. For each question, pregnancies are monitored and the outcome is recorded in the database. RESULTS In total, 75 questions about "anti-cancer drugs and pregnancy" received by 16 Regional Pharmacovigilance Centres between 1997 and 2016 were recorded in Terappel. Breast cancer accounted for 62.7% of the cases, followed by leukaemia (13.3%) and lymphoma (9.3%). Cyclophosphamide is the leading anti-cancer drug with 40.0% of exposed pregnant women, followed by 5-fluorouracil (34.7%), epirubicin (32.0%), tamoxifen (26.7%), and doxorubicin (16.0%). Among the 75 pregnancies, we observed 55 births with 57 children (73.3%) (two cases of twins), nine medical terminations of pregnancy (12.0%), six voluntary terminations of pregnancy (8.0%), three intrauterine foetal deaths (4.0%), and two miscarriages (2.7%). We found a malformation rate of 7.8%. Sixteen of 57 (28.1%) newborns developed one or more neonatal pathologies. CONCLUSION Pregnancy of women taking anti-cancer drugs resulted in birth in 73% of cases. Nevertheless, pregnant women exposed to cancer chemotherapy remains at risk of malformations and neonatal conditions related to prematurity and drugs.
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Affiliation(s)
- Chloé Danet
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | - Mélanie Araujo
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | | | - Ghyslaine Portolan
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | | | - Laurence Vanlemmens
- Centre Oscar-Lambret, Centre Régional de lutte contre le cancer, Lille, France
| | - Sophie Bonenfant
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | | | | | - Thierry Vial
- Centre de Pharmacovigilance, CHU de Lyon, France
| | - Françoise Bavoux
- Centre Régional de Pharmacovigilance, Hôpital Saint-Vincent de Paul, Paris, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | - Christine Damase-Michel
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | - Justine Benevent
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | - Isabelle Bourgeois-Mondon
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | - Isabelle Lacroix
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, CHU de Toulouse, Université de Toulouse, Toulouse, France
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Capriglione S, Manzano A, Gulino FA, Lopez S. Management of gynecological cancer in pregnant patients. ACTA ACUST UNITED AC 2018; 71:133-145. [PMID: 30318875 DOI: 10.23736/s0026-4784.18.04324-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cancer during pregnancy is a rare but challenging condition. More women delay childbearing and consequently the incidence of cancer during pregnancy is constantly increasing. EVIDENCE ACQUISITION An extensive electronic search was performed in PubMed and Scopus. Only studies written after 1985 were considered eligible for this review. Abstracts, conference papers, book chapters, animal studies, commentaries as well as editorials articles were excluded from this review. EVIDENCE SYNTHESIS Cancer treatment during pregnancy is possible, but both maternal and fetal conditions need to be preserved. Randomized clinical trials are not feasible and current evidence are mainly based on case-series, small case reports and expert opinion. Cervical and ovarian cancers are the most common gynecological cancers diagnosed during pregnancy. Surgery and chemotherapy after the first trimester seem to be relatively safe for the newborn. Platinum-based chemotherapy administered during the 2nd-3rd trimester showed comparable adverse effects in newborns to those in the general population. Babies exposed to antenatal chemotherapy might be more likely to develop small for gestational age and NICU admission, than babies not exposed. CONCLUSIONS Management of pregnant women with cancer should be performed in specialized cancer centers and all cases should be discussed with a multidisciplinary approach. In the present review, we discuss the current recommendations for the management of pregnancies complicated by cancer and neonatal outcomes.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynecology, Institute for Social Security, Borgo Maggiore, San Marino
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | | | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA - .,Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Iavazzo C, Minis EE, Gkegkes ID. Current management of gynecologic cancer in pregnancy. J Turk Ger Gynecol Assoc 2018; 19:104-110. [PMID: 29699959 PMCID: PMC5994818 DOI: 10.4274/jtgga.2018.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer during pregnancy is a particularly challenging complication. The incidence has increased in recent years due to childbearing at advanced maternal ages due to career choices and/or the development of reproductive technology. Approximately two thirds of cancer cases during pregnancy comprise invasive cervical cancers and breast cancer. Cancer during gestation is characterized by a need for specialized treatment due to major changes in the hormonal profile (estrogen-progesterone), metabolism (enhancement of anabolism), hemodynamic changes (hyperdynamic circulation), immunologic changes (cell-mediated and humoral immunity), and increased angiogenesis (increased blood flow towards the uterus). Moreover, the management of such patients is based on the trimester of pregnancy, type and stage of cancer, and informed consent of the mother based on her wishes. The optimal treatment of cancer during pregnancy remains elusive because there are limited data from retrospective studies with small samples. As a result, it is crucial that data regarding survival of the women and long-term follow-up of the children from different cancer centers and registries are shared. This need is dictated by the fact that the incidence of cancer during pregnancy will continue to rise as child-bearing age continues to increase.
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Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Ioannis D Gkegkes
- Department of Surgery, General Hospital of Attica “KAT”, Athens, Greece
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Dauti A, Gerstl B, Chong S, Chisholm O, Anazodo A. Improvements in Clinical Trials Information Will Improve the Reproductive Health and Fertility of Cancer Patients. J Adolesc Young Adult Oncol 2017; 6:235-269. [PMID: 28207285 DOI: 10.1089/jayao.2016.0084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There are a number of barriers that result in cancer patients not being referred for oncofertility care, which include knowledge about reproductive risks of antineoplastic agents. Without this information, clinicians do not always make recommendations for oncofertility care. The objective of this study was to describe the level of reproductive information and recommendations that clinicians have available in clinical trial protocols regarding oncofertility management and follow-up, and the information that patients may receive in clinical trials patient information sheets or consent forms. A literature review of the 71 antineoplastic drugs included in the 68 clinical trial protocols showed that 68% of the antineoplastic drugs had gonadotoxic animal data, 32% had gonadotoxic human data, 83% had teratogenic animal data, and 32% had teratogenic human data. When the clinical trial protocols were reviewed, only 22% of the protocols reported the teratogenic risks and 32% of the protocols reported the gonadotoxic risk. Only 56% of phase 3 protocols had gonadotoxic information and 13% of phase 3 protocols had teratogenic information. Nine percent of the protocols provided fertility preservation recommendations and 4% provided reproductive information in the follow-up and survivorship period. Twenty-six percent had a section in the clinical trials protocol, which identified oncofertility information easily. When gonadotoxic and teratogenic effects of treatment were known, they were not consistently included in the clinical trial protocols and the lack of data for new drugs was not reported. Very few protocols gave recommendations for oncofertility management and follow-up following the completion of cancer treatment. The research team proposes a number of recommendations that should be required for clinicians and pharmaceutical companies developing new trials.
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Affiliation(s)
- Angela Dauti
- 1 College of Arts and Sciences, Department of Chemistry, New York University , New York City, New York.,2 Population Sciences Department, Dana-Farber Cancer Institute , Boston, Massachusetts.,3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Brigitte Gerstl
- 4 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia
| | - Serena Chong
- 3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Orin Chisholm
- 5 Department of Pharmaceutical Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Antoinette Anazodo
- 3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia .,4 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia .,6 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital , Randwick, Australia
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Gynaecological cancers coexisting with pregnancy - a literature review. Contemp Oncol (Pozn) 2016; 20:193-8. [PMID: 27647981 PMCID: PMC5013680 DOI: 10.5114/wo.2016.61559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/09/2015] [Indexed: 11/29/2022] Open
Abstract
The coexistence of malignant tumour and pregnancy is a state of simultaneous occurrence of two completely contradictory philosophical and biological phenomena – the development of a new life and a life-threatening terminal illness. Finally, a physician – in fact the whole team of doctors – is facing the fight for two lives: of the mother and her unborn child. The incidence of malignant disease in pregnancy is 0.05 to 0.1%. This condition is a major challenge for physicians because there are no randomised studies that could be the basis to choose the therapeutic methods – the medical knowledge merely comes from case reports, registries, and observational studies. The following cancers most often coexist with pregnancy: gynaecological neoplasm (especially cervical and ovarian cancer), breast cancer, lymphatic system neoplasm, and melanoma. Formerly, the diagnosis was clearly the necessity of abortion. Today – although unskilled doctors still propose the only therapeutic option – termination of pregnancy is not the only solution. The past few years have seen the updating of reports and guidelines for the management of pregnant women with cancer. This paper is a review and summary of the information from these publications.
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Makoshi Z, Perrott C, Al-Khatani K, Al-Mohaisen F. Chemotherapeutic treatment of colorectal cancer in pregnancy: case report. J Med Case Rep 2015; 9:140. [PMID: 26070460 PMCID: PMC4469397 DOI: 10.1186/s13256-015-0621-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 05/25/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Colon cancer in pregnancy is uncommon. Only a small number of case reports have been published in the literature on the use of chemotherapeutic drugs during pregnancy. Reports of such cases assist clinicians in further investigating the use of chemotherapy in pregnancy. CASE PRESENTATION FOLFOX-6 was administered to a pregnant, 33-year-old Saudi woman with metastatic colon cancer from 22 to 30 weeks of gestation. Her cancer was diagnosed during her pregnancy. She tolerated the chemotherapy well and delivered a full-term baby girl with no obvious harm, and normal development was documented at her 2-year follow-up examination. CONCLUSION Colon cancer during pregnancy is not easily detected and is difficult to manage. A detailed history and high clinical suspicion are needed in patients who present with symptoms and signs suggestive of malignancy. A multidisciplinary approach with patient involvement is needed to decrease morbidity and mortality caused by both treatment and the cancer in the mother and to limit side effects for the fetus. Further data and long-term follow-up are needed to better understand the potential long-term side effects of chemotherapeutic drugs on offspring.
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Affiliation(s)
- Ziyad Makoshi
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada.
| | - Claire Perrott
- Southampton School of Medicine, University of Southampton, Southampton, UK.
| | - Khadija Al-Khatani
- Department of Obstetrics and Gynecology, Women's Specialist Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Fadia Al-Mohaisen
- Department of Pathology, King Khalid University Hospital, Riyadh, Saudi Arabia.
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Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, Young J. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG 2012; 119:1572-82. [PMID: 22947229 PMCID: PMC3533794 DOI: 10.1111/j.1471-0528.2012.03475.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective To determine trends in pregnancy-associated cancer and associations between maternal cancer and pregnancy outcomes. Design Population-based cohort study. Setting New South Wales, Australia, 1994–2008. Population A total of 781 907 women and their 1 309 501 maternities. Methods Cancer and maternal information were obtained from linked cancer registry, birth and hospital records for the entire population. Generalised estimating equations with a logit link were used to examine associations between cancer risk factors and pregnancy outcomes. Main outcome measures Incidence of pregnancy-associated cancer (diagnosis during pregnancy or within 12 months of delivery), maternal morbidities, preterm birth, and small- and large-for-gestational-age (LGA). Results A total of 1798 new cancer diagnoses were identified, including 499 during pregnancy and 1299 postpartum. From 1994 to 2007, the crude incidence rate of pregnancy-associated cancer increased from 112.3 to 191.5 per 100 000 maternities (P < 0.001), and only 14% of the increase was explained by increasing maternal age. Cancer diagnosis was more common than expected in women aged 15–44 years (observed-to-expected ratio 1.49; 95% CI 1.42–1.56). Cancers were predominantly melanoma (33.3%) and breast cancer (21.0%). Women with cancer diagnosed during pregnancy had high rates of labour induction (28.5%), caesarean section (40.0%) and planned preterm birth (19.7%). Novel findings included a cancer association with multiple pregnancies (adjusted odds ratio 1.52, 95% CI 1.13–2.05) and LGA (aOR 1.47, 95% CI 1.14–1.89). Conclusions Pregnancy-associated cancers have increased, and this increase is only partially explained by increasing maternal age. Pregnancy increases women’s interaction with health services and the possibility for diagnosis, but may also influence tumour growth.
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Affiliation(s)
- Y Y Lee
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
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Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy. Arch Gynecol Obstet 2012; 286:283-6. [PMID: 22410958 DOI: 10.1007/s00404-012-2287-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/01/2012] [Indexed: 12/29/2022]
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