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Peccatori FA, Florez N, Imbimbo M. From Approximation to Precision: Fertility and Pregnancy Questions in Young Patients With Lung Cancer. J Thorac Oncol 2024; 19:852-854. [PMID: 38849163 DOI: 10.1016/j.jtho.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Fedro A Peccatori
- Division of Gynaecologic Oncology, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
| | - Narjust Florez
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Martina Imbimbo
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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2
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Laguna JC, Tagliamento M, Lambertini M, Hiznay J, Mezquita L. Tackling Non-Small Cell Lung Cancer in Young Adults: From Risk Factors and Genetic Susceptibility to Lung Cancer Profile and Outcomes. Am Soc Clin Oncol Educ Book 2024; 44:e432488. [PMID: 38788188 DOI: 10.1200/edbk_432488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Lung cancer has traditionally been associated with advanced age; however, its increasing incidence among young adults raises concerning questions regarding its etiology and unique considerations for this population. In contrast to the older population, the onset of lung cancer at younger age may be attributed to a complex interplay of incompletely understood individual susceptibility and prevalent environmental risk factors beyond tobacco smoke exposure, such as radon gas and air pollution, which are widespread globally. Consequently, this leads to distinct clinical and molecular profiles, requiring a tailored approach. Furthermore, a diagnosis of cancer represents a threatening event during the prime years of a young person's life, prompting concern about career development, social aspects, fertility aspirations, and physical independence. This poses significant additional challenges for health care professionals in a field that remains underexplored. This comprehensive review recognizes lung cancer in young adults as a distinct entity, exploring its clinical and molecular characteristics, diverse predisposing factors, and priorities in terms of quality of life, with the aim of providing practical support to oncologists and enhancing our understanding of this under-researched population.
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Affiliation(s)
- Juan Carlos Laguna
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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3
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Gouveia I, Xavier M, Silva J, Martins P. Malignant tumour in pregnancy: Ewing-like sarcoma of the gluteal region. BMJ Case Rep 2024; 17:e257493. [PMID: 38649246 PMCID: PMC11043757 DOI: 10.1136/bcr-2023-257493] [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] [Indexed: 04/25/2024] Open
Abstract
We report a case of an Ewing-like sarcoma of the gluteal region with ongoing growth during the second trimester of pregnancy and noted during the third trimester. This lesion was consequently studied to infer its malignant potential. Several examinations were conducted to characterise this lesion, such as ultrasound and MR, which showed signs of tumourous invasion of the deep tissues of the gluteal region.Given that the pregnancy was at the end of the third trimester, the decision was made to schedule the delivery at 37 weeks of gestation and treat the tumour afterwards to balance maternal and fetal health.This case illustrates the need for a detailed investigation and guidance by a multidisciplinary team to provide prenatal counselling regarding a malignant tumour during pregnancy.
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Affiliation(s)
- Inês Gouveia
- Gynecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Marta Xavier
- Gynecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Joana Silva
- Obstetrics & Ginecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Pedro Martins
- Cirurgia Geral, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
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4
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Walters B, Midwinter I, Chew-Graham CA, Jordan KP, Sharma G, Chappell LC, Crosbie EJ, Parwani P, Mamas MA, Wu P. Pregnancy-Associated Cancer: A Systematic Review and Meta-Analysis. Mayo Clin Proc Innov Qual Outcomes 2024; 8:188-199. [PMID: 38524280 PMCID: PMC10957385 DOI: 10.1016/j.mayocpiqo.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
This study aimed to systematically evaluate and quantify the risk of adverse maternal and neonatal outcomes in patients with pregnancy-associated cancer (PAC). This study was conducted from February 13, 2021, through July 24, 2023. A systematic search of MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials was conducted to identify studies reporting outcomes for patients with PAC. The study was registered on PROSPERO. Two reviewers independently conducted screening, data extraction, and quality assessment. The associations were quantified using random-effects meta-analysis. The initial search produced 29,401 titles and abstracts, after which 147 unique full-text articles were screened, of which 22 articles with 59,190 pregnancies with PAC from 70,097,167 births were included in the meta-analysis. Women with PAC were at significantly increased risk of cesarean deliveries (risk ratio [RR], 1.58; 95% CI, 1.31-1.89), preterm birth (RR, 3.07; 95% CI, 2.37-3.98), venous thromboembolism (RR, 6.76; 95% CI, 5.08-8.99), and maternal death (RR, 41.58; 95% CI, 20.38-84.83). The only outcome with reduced risk was instrumental mode of delivery (RR, 0.67; 95% CI, 0.52-0.87). Pregnancy-associated cancer increases risk of adverse outcomes, including a 7-fold risk of venous thromboembolism and a 42-fold risk of maternal death. Further research is required to better understand the mechanisms leading to these adverse outcomes, especially for women who are not diagnosed until the postpartum period. Affected women should have counseling regarding their increased risk of adverse outcomes.
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Affiliation(s)
- Ben Walters
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
| | - India Midwinter
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
| | - Carolyn A. Chew-Graham
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Kelvin P. Jordan
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lucy C. Chappell
- School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Emma J. Crosbie
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA
| | - Mamas A. Mamas
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Pensée Wu
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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5
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Namoju R, Chilaka KN. Protective effect of alpha‑lipoic acid against in utero cytarabine exposure-induced hepatotoxicity in rat female neonates. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03036-4. [PMID: 38459988 DOI: 10.1007/s00210-024-03036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
Cytarabine, an anti-metabolite drug, remains the mainstay of treatment for hematological malignancies. It causes various toxic effects including teratogenicity. Alpha lipoic acid (ALA) is a natural antioxidant reported to offer protection against hepatotoxicity induced by various pathological conditions, drugs, or chemicals. We investigated the protective effect of ALA against prenatal cytarabine exposure-induced hepatotoxicity in rat female neonates. A total of 30 dams were randomly assigned to five groups and received normal saline, ALA 200 mg/kg, cytarabine 12.5 mg/kg, cytarabine 25 mg/kg, and cytarabine 25 mg/kg + ALA 200 mg/kg, respectively, from gestational day (GD)8 to GD21. Cytarabine and ALA were administered via intraperitoneal and oral (gavage) routes, respectively. On postnatal day (PND)1, all the live female neonates (pups) were collected and weighed. The blood and liver from pups were carefully collected and used for histopathological, and biochemical evaluations. A significant and dose-dependent decrease in maternal food intake and weight gain was observed in the pregnant rats (dams) of the cytarabine groups as compared to the dams of the control group. The pups exposed to cytarabine showed a significant and dose-dependent (a) decrease in body weight, liver weight, hepatosomatic index, catalase, superoxide dismutase, glutathione, glutathione peroxidase, serum albumin levels and (b) increase in malondialdehyde, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, AST/ALT ratio, and histopathological anomalies. Maternal co-administration of ALA ameliorated these biochemical changes and histopathological abnormalities by combating oxidative stress. Future studies are warranted to explore the molecular mechanisms involved in the ALA's protective effects against prenatal cytarabine-induced hepatotoxicity.
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Affiliation(s)
- Ramanachary Namoju
- Department of Pharmacology, GITAM School of Pharmacy, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, 530045, India.
- Department of Pharmacology, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, 500075, India.
| | - Kavitha N Chilaka
- Department of Pharmacology, GITAM School of Pharmacy, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, 530045, India
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Mofatteh M, Mashayekhi MS, Arfaie S, Wei H, Kazerouni A, Skandalakis GP, Pour-Rashidi A, Baiad A, Elkaim L, Lam J, Palmisciano P, Su X, Liao X, Das S, Ashkan K, Cohen-Gadol AA. Awake craniotomy during pregnancy: A systematic review of the published literature. Neurosurg Rev 2023; 46:290. [PMID: 37910275 PMCID: PMC10620271 DOI: 10.1007/s10143-023-02187-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
Neurosurgical pathologies in pregnancy pose significant complications for the patient and fetus, and physiological stressors during anesthesia and surgery may lead to maternal and fetal complications. Awake craniotomy (AC) can preserve neurological functions while reducing exposure to anesthetic medications. We reviewed the literature investigating AC during pregnancy. PubMed, Scopus, and Web of Science databases were searched from the inception to February 7th, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Studies in English investigating AC in pregnant patients were included in the final analysis. Nine studies composed of nine pregnant patients and ten fetuses (one twin-gestating patient) were included. Glioma was the most common pathology reported in six (66.7%) patients. The frontal lobe was the most involved region (4 cases, 44.4%), followed by the frontoparietal region (2 cases, 22.2%). The awake-awake-awake approach was the most common protocol in seven (77.8%) studies. The shortest operation time was two hours, whereas the longest one was eight hours and 29 min. The mean gestational age at diagnosis was 13.6 ± 6.5 (2-22) and 19.6 ± 6.9 (9-30) weeks at craniotomy. Seven (77.8%) studies employed intraoperative fetal heart rate monitoring. None of the AC procedures was converted to general anesthesia. Ten healthy babies were delivered from patients who underwent AC. In experienced hands, AC for resection of cranial lesions of eloquent areas in pregnant patients is safe and feasible and does not alter the pregnancy outcome.
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Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
- Neuro International Collaboration (NIC), London, UK.
| | - Mohammad Sadegh Mashayekhi
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Neuro International Collaboration (NIC), Ottawa, ON, Canada
| | - Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
- Neuro International Collaboration (NIC), Montreal, QC, Canada
| | - Hongquan Wei
- Department of 120 Emergency Command Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Arshia Kazerouni
- Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Georgios P Skandalakis
- First Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ahmad Pour-Rashidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abed Baiad
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Lior Elkaim
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Jack Lam
- Department of 120 Emergency Command Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | | | - Xiumei Su
- Obstetrical Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuxing Liao
- Department of Neurosurgery, Foshan Sanshui District People's Hospital, Foshan, China
- Department of Surgery of Cerebrovascular Diseases, Foshan First People's Hospital, Foshan, China
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Keyoumars Ashkan
- Neuro International Collaboration (NIC), London, UK
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's Health Partners Academic Health Sciences Centre, London, UK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Aaron A Cohen-Gadol
- The Neurosurgical Atlas, Carmel, IN, USA
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
- Neuro International Collaboration, Indianapolis, IN, USA
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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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Constantin A, Constantin R, Achim F, Socea B, Predescu D. Pregnancy and Gastric Cancer: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111909. [PMID: 37296761 DOI: 10.3390/diagnostics13111909] [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: 02/27/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Cases of digestive cancers diagnosed during pregnancy are rare. The increasing prevalence of pregnancy in women aged 30-39 years (and not exceptionally 40-49 years) could explain the frequent co-occurrence of cancers and pregnancy. The diagnosis of digestive cancers in pregnancy is difficult due to the overlap between neoplasm symptomatology and the clinical picture of pregnancy. A paraclinical evaluation may also be difficult depending on the trimester of the pregnancy. Diagnosis is also delayed by practitioners' hesitation to use invasive investigations (imaging, endoscopy, etc.) due to fetal safety concerns. Therefore, digestive cancers are often diagnosed during pregnancy in advanced stages, where complications such as occlusions, perforations, and cachexia have already arisen. In this review, we highlight the epidemiology, clinical aspects, paraclinical evaluation, and particularities of the diagnosis and treatment of gastric cancer during pregnancy.
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Affiliation(s)
- Adrian Constantin
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Roxana Constantin
- Department of Obstetrics and Gynecology, Sanador Hospital, 010991 Bucharest, Romania
| | - Florin Achim
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
- Department of Surgery, Sf. Pantelimon Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Dragos Predescu
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
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9
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Gastrointestinal malignancies in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1709-1723. [PMID: 36607401 DOI: 10.1007/s00261-022-03788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023]
Abstract
Gastrointestinal malignancies, though uncommon in pregnancy, present several unique challenges with regards to diagnosis, staging, and treatment. Imaging the pregnant patient with a suspected or confirmed GI malignancy requires modifications to the radiologic modality of choice and protocol in order to minimize harm to the fetus, ensure accuracy in diagnosis and staging and guide treatment decisions. In this review article, we discuss the imaging approach to the pregnant patient with GI cancer, including safe radiologic modalities and modifications to imaging protocols. We also review the most common GI cancers encountered in pregnancy, including colorectal, pancreatic, gastric, and small bowel tumors, with emphasis to imaging findings, staging, and treatment considerations.
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Nishiyama K, Sanefuji M, Kurokawa M, Iwaya Y, Hamada N, Sonoda Y, Ogawa M, Shimono M, Suga R, Kusuhara K, Ohga S. Maternal Chronic Disease and Congenital Anomalies of the Kidney and Urinary Tract in Offspring: A Japanese Cohort Study. Am J Kidney Dis 2022; 80:619-628.e1. [PMID: 35439592 DOI: 10.1053/j.ajkd.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/01/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE Several maternal chronic diseases have been reported as risk factors for congenital anomalies of the kidney and urinary tract (CAKUT) in offspring. However, these investigations used case-control designs, and cases with isolated genitourinary CAKUT were not distinguished from cases in which CAKUT were present with extrarenal congenital anomalies (complicated CAKUT). We examined the association of maternal diseases with isolated and complicated CAKUT in offspring using data from a prospective cohort study. STUDY DESIGN A nationwide prospective birth cohort study. SETTING & PARTICIPANTS 100,239 children enrolled in the Japan Environment and Children's Study between January 2011 and March 2014 at 15 research centers. Physicians' diagnoses in mothers and children were collected from medical record transcripts and questionnaires. EXPOSURES Medical histories of maternal noncommunicable diseases, including obesity, hypertension, diabetes mellitus, kidney disease, hyperthyroidism, hypothyroidism, psychiatric disease, epilepsy, cancer, and autoimmune disease. OUTCOMES CAKUT diagnosed during the first 3 years of life, classified as isolated or complicated. ANALYTICAL APPROACH Multivariable Poisson regression with generalized estimating equations accounting for clustering by clinical center. RESULTS Among the 100,239 children, 560 (0.6%) had CAKUT, comprising 454 (81%) isolated and 106 (19%) complicated forms. The risk of isolated CAKUT was increased in children of mothers who experienced kidney disease (adjusted risk ratio [RR], 1.80 [95% CI, 1.12-2.91]) or cancer (RR, 2.11 [95% CI, 1.15-3.86]). Furthermore, the risk of complicated CAKUT was increased in children of mothers with diabetes mellitus (RR, 3.04 [95% CI, 1.64-5.61]). LIMITATIONS Lack of standardization or prespecification of clinical definitions, diagnostic criteria, measurements, and testing. Genetic testing was not performed. CONCLUSIONS Isolated CAKUTs and complicated CAKUTs were associated with different maternal diseases. The results may inform clinical management of pregnancy and highlight potential differences in the genesis of isolated and complicated forms of CAKUT.
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Affiliation(s)
- Kei Nishiyama
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Mari Kurokawa
- Department of Pediatrics, Fukuoka Higashi Medical Center, Koga, Fukuoka, Japan
| | - Yuka Iwaya
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Norio Hamada
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuri Sonoda
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanobu Ogawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Shimono
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan; Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reiko Suga
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan; Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shouichi Ohga
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
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11
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Koutras A, Ntounis T, Fasoulakis Z, Papalios T, Pittokopitou S, Prokopakis I, Syllaios A, Valsamaki A, Chionis A, Symeonidis P, Samara AA, Pagkalos A, Pergialiotis V, Theodora M, Antsaklis P, Daskalakis G, Kontomanolis EN. Cancer Treatment and Immunotherapy during Pregnancy. Pharmaceutics 2022; 14:pharmaceutics14102080. [PMID: 36297515 PMCID: PMC9611953 DOI: 10.3390/pharmaceutics14102080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background/aim: Immunotherapy has, in recent years, witnessed an expansion in its indications for the treatment of cancer. Coupled with the fact that, nowadays, even more women choose to postpone parenthood, thus increasing their chances of having some kind of malignancy during pregnancy, more and more women are eligible for receiving immunotherapy during this period of their lives. The cases of cancer diagnosed during pregnancy is an ever-increasing trend nowadays. Materials and methods: The oncologists and clinicians treating women often face a range of ethical and therapeutic dilemmas due to the particularity of the patient’s conditions. The primary concern is the protection of the mother, firstly, and then the fetus (through adjustments to the various treatment regimens) if possible. Results and conclusions: Oncological drugs, radiation therapy, surgery, or a combination of all the above methods are selected, depending on the case. In this project, we studied the oncology drugs used for various types of gestational cancer, their appropriateness and timing, as well as their possible effects on the parent and embryo upon their administration. Various studies have shown that the administration of oncological drugs should be postponed until at least after the first trimester of pregnancy.
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Affiliation(s)
- Antonios Koutras
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-694567622
| | - Thomas Ntounis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Theodoros Papalios
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Savia Pittokopitou
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Ioannis Prokopakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Athanasios Syllaios
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma Str. 17, 11527 Athens, Greece
| | - Asimina Valsamaki
- Department of Internal Medicine, Koutlimbaneio and Triantafylleio General Hospital of Larissa, Tsakalof Str. 1, 41221 Larisa, Greece
| | - Athanasios Chionis
- Department of Obstetrics and Gynecology, Laikon General Hospital of Athens, Agiou Thoma Str. 17, 11527 Athens, Greece
| | - Panagiotis Symeonidis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis–Makris, 68100 Alexandroupolis, Greece
| | - Athina A. Samara
- Department of Embryology, University General Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
| | - Athanasios Pagkalos
- Department of Obstetrics and Gynecology, General Hospital of Xanthi, Neapoli, 67100 Xanthi, Greece
| | - Vasilios Pergialiotis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Marianna Theodora
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Panos Antsaklis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Emmanuel N. Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis–Makris, 68100 Alexandroupolis, Greece
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12
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Abdel-Rahman O, Ghosh S. Pregnancy and perinatal outcomes following exposure to antineoplastic agents around pregnancy within the US FDA Adverse Event Reporting System. Future Oncol 2022; 18:2635-2642. [PMID: 35611663 DOI: 10.2217/fon-2021-1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To review pregnancy and perinatal outcomes associated with exposure to antineoplastic drugs around pregnancy as reported within the US FDA Adverse Event Reporting System (FAERS). Methods: The FAERS database was accessed and reports of exposure to antineoplastic drugs before/during pregnancy 2000-2020 were reviewed. An analysis of the frequency of different adverse pregnancy outcomes and perinatal outcomes was conducted for all agents as well as for specific categories of antineoplastic agents. Results: A total of 5312 reports of pregnancy exposure to antineoplastic drugs within the FAERS database were found to be eligible and were included in the current study. The most frequent adverse pregnancy outcomes included premature delivery (21.8%) and abortion (11.9%). The most frequent adverse perinatal outcomes included congenital malformations (15.9%) and fetal/neonatal death (12.9%). Conclusions: Within the limitations of the study (especially the lack of an accurate denominator), premature delivery, abortion, fetal/neonatal death and congenital malformations seemed to be the main risks associated with pregnancy exposure to antineoplastic drugs.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada
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13
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The neonatal characteristics of congenital defects of the kidney and urinary tract – our experience. GINECOLOGIA.RO 2022. [DOI: 10.26416/gine.38.4.2022.7394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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14
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Goyal S, Yadav A, Madan R, Chitkara A, Singh R, Khosla D, Kumar N. Managing brain tumors in pregnancy: The oncologist's struggle with maternal-fetal conflict. J Cancer Res Ther 2022; 18:5-18. [DOI: 10.4103/jcrt.jcrt_1343_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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15
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Garg S, Maurya DK, Sasidharan GM, Prem SS, Ganesan P, Govindarajalou R, Plakkal N, Keepanasseril A. Management dilemmas in pineoblastoma recurrence diagnosed during pregnancy. Obstet Med 2021; 14:181-186. [PMID: 34646348 DOI: 10.1177/1753495x20958339] [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: 05/06/2020] [Accepted: 08/22/2020] [Indexed: 11/16/2022] Open
Abstract
Pineoblastoma is an extremely rare intracranial neoplasm, with increased risk of craniospinal metastasis. There is only one case reported in the literature who presented during pregnancy. Described here is a woman who presented at five months of gestation with recurrence of pineoblastoma, who had previously defaulted adjuvant therapy following surgical decompression. The challenges in the diagnosis and treatment of pineoblastoma and its effects on pregnancy are also discussed.
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Affiliation(s)
- Sonal Garg
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Dilip K Maurya
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Gopalakrishnan M Sasidharan
- Department of Neurosurgery, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Shyama S Prem
- Department of Radiation Oncology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ramkumar Govindarajalou
- Department of Radiology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
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16
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Andrikopoulou A, Korakiti AM, Apostolidou K, Dimopoulos MA, Zagouri F. Immune checkpoint inhibitor administration during pregnancy: a case series. ESMO Open 2021; 6:100262. [PMID: 34487972 PMCID: PMC8426195 DOI: 10.1016/j.esmoop.2021.100262] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have been widely implemented in current clinical practice. Although cancer occurs in ∼1 out of 1000 pregnancies, treatment remains challenging. Until now, limited data exist regarding immunotherapy administration during pregnancy. This systemic review aims to synthesize all available data from immunotherapy administration in pregnant women and evaluate the efficacy and safety of immunotherapy during pregnancy. PATIENTS AND METHODS Eligible studies were identified by a search of the PubMed Medline database and Food and Drug Administration Adverse Events Reporting System Public Dashboard for the period 1 January 2000 to 1 April 2021; the algorithm consisted of a predefined combination of the words 'immunotherapy', 'cancer' and 'pregnancy'. PRISMA guidelines were applied in this study. RESULTS Overall, seven articles (seven pregnancies, nine neonates) were retrieved. The mean duration of immunotherapy administration was 9.8 weeks [standard deviation (SD): 11.27; median: 7.0; range: 1-32]. In all cases specified, melanoma was the malignancy reported. The mean gestational age at delivery was 30.4 weeks (SD: 5.03; median: 32.0; range: 24-38), whereas the mean weight of neonates at delivery was 1267 g (SD: 412.0; median: 1400; range: 590-1701). Only one neonate was born term at 38 weeks of pregnancy (11.1%; 1/9). Complications during pregnancy were observed in 71.4% of cases: intrauterine growth restriction (three cases), HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) (one case), placental insufficiency (one case) and low fetal heart rate (one case). The mean progression-free survival and overall survival were 16.0 and 25.2 months, respectively. CONCLUSION The administration of immune checkpoint inhibitors during pregnancy is associated with increased incidence of pregnancy complications, prematurity and low birth weight. The administration of these regimens is not recommended during gestation. Whenever applied, close monitoring of the mother and the fetus is required.
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Affiliation(s)
- A Andrikopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A M Korakiti
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - K Apostolidou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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17
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Hassel JC, Livingstone E, Allam JP, Behre HM, Bojunga J, Klein HH, Landsberg J, Nawroth F, Schüring A, Susok L, Thoms KM, Kiesel L, Berking C. Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy. ESMO Open 2021; 6:100248. [PMID: 34438241 PMCID: PMC8390524 DOI: 10.1016/j.esmoop.2021.100248] [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: 04/01/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 01/09/2023] Open
Abstract
Melanoma is one of the most common cancers in adolescents and adults at fertile age, especially in women. With novel and more effective systemic therapies that began to profoundly change the dismal outcome of melanoma by prolonging overall survival, the wish for fertility preservation or even parenthood has to be considered for a growing portion of melanoma patients-from the patients' as well as from the physicians' perspective. The dual blockade of the mitogen-activated protein kinase pathway by B-Raf proto-oncogene serine/threonine kinase and mitogen-activated protein kinase inhibitors and the immune checkpoint inhibition by anti-programmed cell death protein 1 and anti-cytotoxic T-lymphocyte-associated protein-4 monoclonal antibodies constitute the current standard systemic approaches to combat locally advanced or metastatic melanoma. Here, the preclinical data and clinical evidence of these systemic therapies are reviewed in terms of their potential gonadotoxicity, teratogenicity, embryotoxicity and fetotoxicity. Recommendations for routine fertility and contraception counseling of melanoma patients at fertile age are provided in line with interdisciplinary recommendations for the diagnostic work-up of these patients and for fertility-protective measures. Differentiated recommendations for the systemic therapy in both the adjuvant and the advanced, metastatic treatment situation are given. In addition, the challenges of pregnancy during systemic melanoma therapy are discussed.
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Affiliation(s)
- J C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - J P Allam
- Department of Andrology, University Hospital Bonn, Bonn, Germany
| | - H M Behre
- Center for Reproductive Medicine and Andrology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - J Bojunga
- Department of Endocrinology, Diabetology and Nutrition Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - H H Klein
- Department of Internal Medicine, Endocrinology & Diabetology & Gastroenterology and Hepatology, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - J Landsberg
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - F Nawroth
- Center for Infertility, Prenatal Medicine, Endocrinology and Osteology, Amedes Medical Center MVZ Hamburg, Hamburg, Germany
| | - A Schüring
- Fertility Center MVZ KITZ Regensburg, Regensburg, Germany
| | - L Susok
- Department of Dermatology, University Hospital Bochum, Bochum, Germany
| | - K M Thoms
- Department of Dermatology, Venereology and Allergy, University Medical Center Goettingen, Goettingen, Germany
| | - L Kiesel
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - C Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen EMN, Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany.
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18
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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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19
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Term Pregnancy After Complete Response of Placental Site Trophoblastic Tumor to Immunotherapy. Obstet Gynecol 2021; 138:115-118. [PMID: 34259474 DOI: 10.1097/aog.0000000000004434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Standard treatment for placental site trophoblastic tumor is hysterectomy. This may be unacceptable to women desiring fertility. Cells aberrant in placental site trophoblastic tumor display an ability to invade normal tissue while evading the immune system. CASE We present a case of a 23-year-old woman with stage I placental site trophoblastic tumor who declined hysterectomy. Tumor assay for program cell death-ligand 1 staining was performed and suggestive of an immune-responsive tumor. The patient initiated intravenous pembrolizumab 200 mg every 2 weeks, and by cycle 3 her β-hCG level fell to undetectable. She subsequently conceived and went on to have an uncomplicated term vaginal birth after cesarean. At 6 weeks postpartum, she remained without evidence of disease. CONCLUSION Immunotherapy can eliminate early program cell death-ligand 1-positive placental site trophoblastic tumor with subsequent normal pregnancy.
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20
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Lorenzi E, Simonelli M, Persico P, Dipasquale A, Santoro A. Risks of molecular targeted therapies to fertility and safety during pregnancy: a review of current knowledge and future needs. Expert Opin Drug Saf 2021; 20:503-521. [PMID: 33600273 DOI: 10.1080/14740338.2021.1893299] [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] [Indexed: 12/17/2022]
Abstract
INTRODUCTION As the population of young cancer survivors is increasing and a trend toward postponing pregnancy later in life is reported, more efforts are focused toward understanding treatment-induced sequelae, in particular, the effects of cancer and/or treatment on fertility. AREA COVERED Whereas the fertility risk of cytotoxic agents for both men and women is well recognized, the impact of molecular-targeted therapy (MTT) on fertility parameters, their teratogenic potential and pregnancy outcome/management in case of an accidental exposure are not established. We update available clinical data on the impact of new MTTs on fertility in both sexes, their potential teratogenic effects and the outcome of pregnancy during accidental exposure. Agents are categorized by class and the potential relevance of their target signaling pathways to gonadal maturation. EXPERT OPINION The majority of MTTs have worrying preclinical data discouraging their use during pregnancy and reinforcing the idea that they can induce impairment in gonadal function. However, it does not mean that all MTTs result in permanent infertility and that they should be completely avoided during pregnancy. The current review provides a critical evaluation on the most commonly used MTTs, offering a possible guide for clinicians.
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Affiliation(s)
- Elena Lorenzi
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Matteo Simonelli
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Pasquale Persico
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Angelo Dipasquale
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Armando Santoro
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
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21
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Wang L, Huang S, Sheng X, Ren C, Wang Q, Yang L, Zhao S, Xu T, Ma X, Guo R, Sun P, Lin Y, Li Y, Wang J, Wang Y. Malignant Ovarian Tumors During Pregnancy: A Multicenter Retrospective Analysis. Cancer Manag Res 2020; 12:10841-10848. [PMID: 33149689 PMCID: PMC7605603 DOI: 10.2147/cmar.s271806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/06/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose The aim of this study was to investigate the clinical characteristics and management of malignant ovarian tumors during pregnancy, as well as the feto-maternal outcomes and analyze the influential factors on the pregnancy outcomes. Patients and Methods Eighty-five patients with ovarian malignancies during pregnancy treated at 12 tertiary hospitals between 2009 and 2019 were analyzed in this study. The clinical features, histopathological characteristics, clinical management, and maternal and perinatal outcomes were retrospectively analyzed. The clinical features and managements were compared between abortion group and live birth group. Results The following diagnoses were made: 41 (48.24%) patients with borderline ovarian tumors, 18 (21.18%) patients with epithelial ovarian cancers, 17 (20.00%) patients with non-epithelial ovarian malignancies and 9 (10.59%) patients with metastatic ovarian tumors. Thirty-six (42.45%) patients underwent conservative surgical treatment. Thirty-four (40.00%) patients opted for fertility-sparing surgery, and fifteen (17.56%) patients received radical surgery. Chemotherapy was administered to 32.94% of the patients. The proportion of ovarian malignancies diagnosed in the first trimester in the abortion group was higher than that in the live birth group (P<0.05). However, tumor diameter, reproductive history, stage and surgical indications showed no significant differences between groups. A total of 67 live babies were recorded in this study, including 19 premature babies and 1 full-term newborn who died of respiratory distress. All of the BOTs were diagnosed with stage I, among whom 38 (92.68%) patients exhibited disease-free survival. Twenty-eight ovarian cancers were in stage I–II and 26 of them had disease-free survival with the longest follow-up time of 10 years. Five of the sixteen patients in advanced stage (stage III–IV) died, four of whom had metastatic tumors. Conclusion Pregnant women with early-stage malignant ovarian tumors appear to have favorable outcomes. Conservative surgery is acceptable for early-stage borderline ovarian tumors during pregnancy. The gestational age of ovarian malignancy detection is key for pregnancy outcomes.
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Affiliation(s)
- Liya Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
| | - Shenjiao Huang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Centre, Guangzhou 510623, People's Republic of China
| | - Xiujie Sheng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Major Obstetric Diseases of Guangdong Province, Guangzhou 510150, People's Republic of China
| | - Chenchen Ren
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Qiming Wang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Ningbo City, Ningbo 315012, People's Republic of China
| | - Linqing Yang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining 272029, People's Republic of China
| | - Shuping Zhao
- Department of Gynecology, Women and Children's Hospital of Qingdao, Qingdao 266000, People's Republic of China
| | - Tianmin Xu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130000, People's Republic of China
| | - Xiaoxin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated of China Medical University, Shenyang 110004, People's Republic of China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Pengming Sun
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Yang Lin
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130000, People's Republic of China
| | - Yuhong Li
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
| | - Jiandong Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, People's Republic of China
| | - Yudong Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
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Dong J, Zhao Y, Xu W. Case Report: Retroperitoneal Laparoscopic Partial Nephrectomy for T2 Renal Cell Carcinoma During Pregnancy. Front Oncol 2020; 10:552228. [PMID: 33163398 PMCID: PMC7591673 DOI: 10.3389/fonc.2020.552228] [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: 04/15/2020] [Accepted: 08/21/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction: Renal cell carcinoma (RCC) found during pregnancy is rare. Treatment strategies and timing of surgeries are controversial. Retroperitoneal laparoscopic partial nephrectomy for T2 RCC during pregnancy has not been reported before. Patient Concerns and Diagnosis: Herein, we report a case of T2 RCC found in a 36-year-old woman during her 21st week of pregnancy. Both ultrasound and magnetic resonance imaging (MRI) suggested a malignancy, possibly renal cell carcinoma. Interventions and Outcomes: After discussion with a multidisciplinary team, the tumor was removed completely via retroperitoneal laparoscopic partial nephrectomy, and pathology result was clear cell RCC. A male infant was delivered full-term uneventful, and both the patient and the boy were in good health after a 46-month follow-up. Conclusion: Partial nephrectomy with retroperitoneal laparoscopic technique is feasible and recommended in some T2 RCC patients.
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Affiliation(s)
- Jie Dong
- Urology Department of Peking Union Medical College Hospital, Beijing, China
| | - Yi Zhao
- Urology Department of Peking Union Medical College Hospital, Beijing, China
| | - Weifeng Xu
- Urology Department of Peking Union Medical College Hospital, Beijing, China
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23
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Bacha JM, El-Mallawany NK, Slone JS, Wilkinson JP, Mehta PS, Campbell LR. Recommendations for treating life-threatening Kaposi sarcoma during pregnancy in HIV-positive women in low income countries. Int J STD AIDS 2020; 31:724-734. [PMID: 32493141 DOI: 10.1177/0956462420920160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In areas of high HIV and human herpes virus 8 prevalence, life-threatening forms of Kaposi sarcoma (KS) can occur in HIV-positive women during pregnancy. Treating KS in pregnancy must balance both the well-being of the mother with the health of the fetus, yet data and recommendations on the best treatment approach for KS during pregnancy are limited. Without effective treatment, which can be difficult to obtain in low income countries (LICs), the mother and infant are at risk for poor outcomes. A successful case report is used as teaching example, followed by a detailed review of the literature that culminates in recommendations for treating KS during pregnancy among HIV-positive women in LICs. A 31-year-old HIV-positive woman presented for care in April 2016 at 28 weeks gestation with extensive KS skin lesions, KS lymphadenopathy, and a large oropharynx KS lesion causing partial airway obstruction. She had initiated antiretroviral therapy (ART) months prior and was virally suppressed, suggesting KS-immune reconstitution inflammatory syndrome. Due to the severity of KS and her third trimester status, combination chemotherapy was initiated using bleomycin, vincristine, and doxorubicin followed by maintenance therapy with paclitaxel. She showed remarkable response to the chemotherapy and had a normal vaginal delivery of a healthy baby at full term. Full clinical remission was achieved, and her baby was HIV-negative with no negative health effects of the KS or the chemotherapy. Review of the sparse existing literature demonstrates the importance, safety, and effectiveness of treating KS during pregnancy. We offer simple adaptable treatment recommendations for use in treating HIV-positive women with KS during pregnancy in LICs. Life-threatening KS can be treated using chemotherapy and ART in resource-limited settings, allowing for good outcomes in mother and infant. While monotherapy with liposomal doxorubicin or paclitaxel is preferred, these are often not available in LICs. As alternatives, bleomycin, vincristine, and doxorubicin can be safely used during the second and/or third trimesters for treating KS. Following a simple treatment approach can be an effective way to treat KS in pregnancy for pregnant women living with HIV in an LIC setting.
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Affiliation(s)
- Jason M Bacha
- Baylor College of Medicine Children's Foundation - Tanzania, Mbeya, Tanzania.,Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Nader K El-Mallawany
- Baylor College of Medicine - Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Jeremy S Slone
- Baylor College of Medicine - Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Jeffrey P Wilkinson
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Global Women's Health, Houston, TX, USA
| | - Parth S Mehta
- Baylor College of Medicine - Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Liane R Campbell
- Baylor College of Medicine Children's Foundation - Tanzania, Mbeya, Tanzania.,Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Bar-Joseph H, Peccatori FA, Goshen-Lago T, Cribiù FM, Scarfone G, Miller I, Nemerovsky L, Levi M, Shalgi R, Ben-Aharon I. Cancer During Pregnancy: The Role of Vascular Toxicity in Chemotherapy-Induced Placental Toxicity. Cancers (Basel) 2020; 12:cancers12051277. [PMID: 32443608 PMCID: PMC7281110 DOI: 10.3390/cancers12051277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023] Open
Abstract
Breast cancer is diagnosed in ~0.3% of pregnant women. Studies that have addressed gestational and neonatal outcomes of chemotherapy during pregnancy have demonstrated increased gestational complications including preeclampsia and intrauterine growth retardation. We hypothesized that anthracycline-induced gestational complications could be derived from direct toxicity on the placenta vasculature. Pregnant ICR mice (day E12.5) were treated with doxorubicin (DXR; 8 mg/kg) or saline, while their umbilical cord blood flow was imaged by pulse-wave (PW) Doppler. Mice were euthanized on day E18.5, and their embryos and placentae were collected for further analysis. Unlike control mice, the DXR-treated mice presented an acute change in the umbilical cord’s blood flow parameters (velocity time integral and heart rate interval), reduced embryos’ weight, reduced placenta efficiency, and modulation in vascular-related pathways of treated placenta proteomics. Apoptosis and proliferation were also enhanced, as demonstrated by TUNEL and proliferating cell nuclear antigen (PCNA) analysis. We further examined the placentae of patients treated with epirubicin (EPI), who had been diagnosed with breast cancer during pregnancy (weeks 27–35). The immunohistochemistry of the EPI-treated human placentae showed enhanced proliferation and apoptosis as compared with matched chemo-naïve placentae, as well as reduced neovascularization (CD34). Our findings suggest that anthracycline-induced vascular insult promotes placental toxicity, and could point to potential agents designated to offset the damage and to reduce gestational complications in pregnant cancer patients.
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Affiliation(s)
- Hadas Bar-Joseph
- The Transgenic Mice, Cryopreservation and Assisted Reproduction (TMCR) Unit, Veterinary Service Center, Tel Aviv University, Ramat Aviv, 69978 Tel Aviv, Israel;
| | | | | | - Fulvia Milena Cribiù
- Pathology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giovanna Scarfone
- Department of Gynecological Oncology, Fondazione Cà Granda Policlinico Ospedale Maggiore of Milano, 20122 Milan, Italy;
| | - Irit Miller
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, 69978 Tel-Aviv, Israel; (I.M.); (L.N.); (M.L.); (R.S.)
| | - Luba Nemerovsky
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, 69978 Tel-Aviv, Israel; (I.M.); (L.N.); (M.L.); (R.S.)
| | - Mattan Levi
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, 69978 Tel-Aviv, Israel; (I.M.); (L.N.); (M.L.); (R.S.)
| | - Ruth Shalgi
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, 69978 Tel-Aviv, Israel; (I.M.); (L.N.); (M.L.); (R.S.)
| | - Irit Ben-Aharon
- Oncology, Rambam Health Care Center, 3109601 Haifa, Israel;
- Technion Integrated Cancer Center (TICC), Faculty of Medicine, Technion, 3200003 Haifa, Israel
- Correspondence:
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25
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Buckingham L, Janssen M, Ray EM, Tucker K, Davidson BA, Arenth J, Lefkowits C, Jones JA, Gehrig P, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Serious Illness in Pregnancy. J Palliat Med 2020; 23:712-718. [PMID: 31928374 DOI: 10.1089/jpm.2019.0651] [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] [Indexed: 11/12/2022] Open
Abstract
Palliative care (PC) teams are increasingly being called upon to provide care earlier and more remote from end of life. Because much of the field has grown out of hospice and geriatric care, most teams have little to no experience caring for pregnant women or their fetuses when serious or life-threatening illness strikes. This article, written by a team of oncologists (gynecologic, medical, and radiation) and PC providers, seeks to demystify the care of seriously ill pregnant women and their fetuses by exploring the diagnostic, treatment, prognostication, symptom management, and communication needs of these patients. Truly comprehensive PC extends throughout the life span, from conception to death, regardless of age. Accordingly, increased knowledge of the unique needs of these vulnerable groups will enhance our ability to provide care across this continuum.
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Affiliation(s)
- Lindsey Buckingham
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew Janssen
- Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily M Ray
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine Tucker
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Joshua Arenth
- Divisions of Pediatric Critical Care and Pediatric Palliative Care, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carolyn Lefkowits
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Division of Palliative Care, Department of Internal Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joshua A Jones
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paola Gehrig
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher A Jones
- Department of Medicine and the Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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26
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Incidence of Neonatal Neutropenia, Leukopenia, and Anemia After In Utero Exposure to Chemotherapy For Maternal Cancer. Am J Clin Oncol 2019; 42:810-811. [DOI: 10.1097/coc.0000000000000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Shah NM, Scott DM, Kandagatla P, Moravek MB, Cobain EF, Burness ML, Jeruss JS. Young Women with Breast Cancer: Fertility Preservation Options and Management of Pregnancy-Associated Breast Cancer. Ann Surg Oncol 2019; 26:1214-1224. [PMID: 30680478 PMCID: PMC6458084 DOI: 10.1245/s10434-019-07156-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy diagnosed in women of childbearing age. A breast cancer diagnosis in this young patient population can be uniquely complex to navigate when considering the potential impact of fertility loss associated with specific gonadotoxic therapies. Another unique challenge for young breast cancer patients is pregnancy-associated breast cancer (PABC), which occurs in approximately 1 of every 3000 pregnancies. Pregnancy adds a layer of complexity to breast cancer treatment planning as many therapies can affect the developing fetus. These two clinical challenges require nuanced multidisciplinary approaches to facilitate optimal treatment outcomes. We sought to review and summarize the management strategy options for both fertility preservation and PABC. METHODS A guideline and literature review was performed for fertility preservation, young patients with breast cancer, and pregnancy-associated breast cancer. RESULTS Fertility preservation options, both established and experimental, are detailed. Suggested clinical practice guidelines for PABC are also presented, which delineate breast cancer treatment recommendations based on pregnancy trimester. CONCLUSION A multidisciplinary approach to patient care, including oncologists and early referral to reproductive specialists, can provide young breast cancer patients with options for fertility preservation. Under the guidance of a multidisciplinary treatment team, PABC can also be diagnosed and treated to permit the best possible outcomes for the mother and the developing fetus.
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Affiliation(s)
- Nikita M Shah
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Dana M Scott
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Pridvi Kandagatla
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, Henry Ford Health System/Wayne State University, Detroit, MI, USA
| | - Molly B Moravek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Erin F Cobain
- Division of Medical Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Monika L Burness
- Division of Medical Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jacqueline S Jeruss
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
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28
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Hepner A, Negrini D, Hase EA, Exman P, Testa L, Trinconi AF, Filassi JR, Francisco RPV, Zugaib M, O'Connor TL, Martin MG. Cancer During Pregnancy: The Oncologist Overview. World J Oncol 2019; 10:28-34. [PMID: 30834049 PMCID: PMC6396773 DOI: 10.14740/wjon1177] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 01/11/2023] Open
Abstract
Although a rare and challenging condition, cancer during pregnancy should promptly be identified and treated. Not only standards of care guidelines for the underlying disease are taken into account, but also fetal safety might be weighted for clinical decisions. Frequent lack of experience and knowledge about this condition could lead to late diagnosis, imprecise management, suboptimal treatment and fetal and maternal harm. Therefore, this review aims to summarize the current evidence regarding the epidemiology, clinical presentation, diagnostic workup, staging and treatment, including novel treatment modalities for patients diagnosed with cancer during pregnancy.
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Affiliation(s)
- Adriana Hepner
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Negrini
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eliane Azeka Hase
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Pedro Exman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura Testa
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Angela F Trinconi
- Mastology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jose Roberto Filassi
- Mastology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Tracey L O'Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, The Jacobs School of Medicine, University of Buffalo, Buffalo, NY, USA
| | - Michael Gary Martin
- Division of Hematology and Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN, USA
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29
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Li X, Yao Z, Jiang X, Sun J, Ran G, Yang X, Zhao Y, Yan Y, Chen Z, Tian L, Bai W. Bioactive compounds from Cudrania tricuspidata: A natural anticancer source. Crit Rev Food Sci Nutr 2018; 60:494-514. [PMID: 30582344 DOI: 10.1080/10408398.2018.1541866] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The tumor is becoming a critical threat to our lives in these years. Searching for antitumor substances from natural products is a great interest of scientists. Cudrania tricuspidata (C. tricuspidata) is a regional plant containing 158 flavonoids and 99 xanthones, and others ingredients with favorable bioactivity. This review comprehensively analyzes the antitumor compounds from C. tricuspidata against different tumors, and 78 flavonoids plus xanthones are considered as underlying antineoplastic. Importantly, the structure of preylation groups is the primary source of antitumor activity among 45 flavonoids plus xanthones, which could be a direction of structural modification for a better antitumor ability. Additionally, the fruits are also preferable sources of antitumor compounds compared to the roots and barks due to the abundant isoflavones and sustainability. However, many studies only focused on the cells viability inhibition of the compounds, the underlying molecular mechanisms, and the intracellular targets remain ambiguous. In conclusion, C. tricuspidata has a great potential for anti-tumor prevention or therapy, but more attention should be paid to deeper research in vitro and in vivo models.
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Affiliation(s)
- Xusheng Li
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
| | - Zilan Yao
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
| | - Xinwei Jiang
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
| | - Jianxia Sun
- >Department of Food Science and Engineering, Faculty of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou, PR China
| | - Guojing Ran
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
| | - Xuan Yang
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
| | - Yaqi Zhao
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
| | - Ying Yan
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
| | - Zisheng Chen
- Department of Respiratory Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, PR China
| | - Lingmin Tian
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
| | - Weibin Bai
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou, PR China
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30
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Flint TR, Jones JO, Ferrer M, Colucci F, Janowitz T. A comparative analysis of immune privilege in pregnancy and cancer in the context of checkpoint blockade immunotherapy. Semin Oncol 2018; 45:170-175. [PMID: 30262396 DOI: 10.1053/j.seminoncol.2018.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022]
Abstract
Despite their abilities to elicit immune responses, both syngeneic tumors and the half-mismatched placenta grow in the host, unlike a tissue allograft that is aggressively rejected. This is because of local and systemic factors that contribute to the immunologic privilege of tumors and the placenta. Checkpoint blockade immunotherapies subvert this privilege, with spectacularly beneficial outcomes in subsets of patients with certain types of cancer. A challenge for the community of scientists and clinicians is to replicate these successes in pregnant patients with cancer, without harm to the placenta. Here we compare and contrast the immunology of cancers and the placenta, and suggest that immunotherapy for pregnant patients with cancer may be a reasonable option, but that this should be explored systematically.
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Affiliation(s)
- Thomas R Flint
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - James O Jones
- Department of Oncology, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and Addenbrooke's Hospital, Cambridge, UK; MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge Biomedical Campus, Cambridge, UK
| | - Miriam Ferrer
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - Francesco Colucci
- Centre for Trophoblast Research, University of Cambridge and Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Tobias Janowitz
- Department of Oncology, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK.
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31
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Jiraskova L, Cerveny L, Karbanova S, Ptackova Z, Staud F. Expression of Concentrative Nucleoside Transporters ( SLC28A) in the Human Placenta: Effects of Gestation Age and Prototype Differentiation-Affecting Agents. Mol Pharm 2018; 15:2732-2741. [PMID: 29782174 DOI: 10.1021/acs.molpharmaceut.8b00238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Equilibrative ( SLC29A) and concentrative ( SLC28A) nucleoside transporters contribute to proper placental development and mediate uptake of nucleosides/nucleoside-derived drugs. We analyzed placental expression of SLC28A mRNA during gestation. Moreover, we studied in choriocarcinoma-derived BeWo cells whether SLC29A and SLC28A mRNA levels can be modulated by activity of adenylyl cyclase, retinoic acid receptor activation, CpG islands methylation, or histone acetylation, using forskolin, all- trans-retinoic acid, 5-azacytidine, and sodium butyrate/sodium valproate, respectively. We found that expression of SLC28A1, SLC28A2, and SLC28A3 increases during gestation and reveals considerable interindividual variability. SLC28A2 was shown to be a dominant subtype in the first-trimester and term human placenta, while SLC28A1 exhibited negligible expression in the term placenta only. In BeWo cells, we detected mRNA of SLC28A2 and SLC28A3. Levels of the latter were affected by 5-azacytidine and all- trans-retinoic acid, while the former was modulated by sodium valproate (but not sodium butyrate), all- trans-retinoic acid, 5-azacytidine, and forskolin that caused 25-fold increase in SLC28A2 mRNA; we documented by analysis of syncytin-1 that the observed changes in SLC28A expression do not correlate with the morphological differentiation state of BeWo cells. Upregulated SLC28A2 mRNA was reflected in elevated uptake of [3H]-adenosine, high-affinity substrate of concentrative nucleoside transporter 2. Using KT-5720 and inhibitors of phosphodiesterases, we subsequently confirmed importance of cAMP/protein kinase A pathway in SLC28A2 regulation. On the other hand, SLC29A genes exhibited constitutive expression and none of the tested compounds increased SLC28A1 expression to detectable levels. In conclusion, we provide the first evidence that methylation status and activation of retinoic acid receptor affect placental SLC28A2 and SLC28A3 transcription and substrates of concentrative nucleoside transporter 2 might be taken up in higher extent in placentas with overactivated cAMP/protein kinase A pathway and likely in the term placenta.
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Affiliation(s)
- Lucie Jiraskova
- Department of Pharmacology and Toxicology , Charles University, Faculty of Pharmacy in Hradec Kralove , Akademika Heyrovskeho 1203 , 50005 Hradec Kralove , Czech Republic
| | - Lukas Cerveny
- Department of Pharmacology and Toxicology , Charles University, Faculty of Pharmacy in Hradec Kralove , Akademika Heyrovskeho 1203 , 50005 Hradec Kralove , Czech Republic
| | - Sara Karbanova
- Department of Pharmacology and Toxicology , Charles University, Faculty of Pharmacy in Hradec Kralove , Akademika Heyrovskeho 1203 , 50005 Hradec Kralove , Czech Republic
| | - Zuzana Ptackova
- Department of Pharmacology and Toxicology , Charles University, Faculty of Pharmacy in Hradec Kralove , Akademika Heyrovskeho 1203 , 50005 Hradec Kralove , Czech Republic
| | - Frantisek Staud
- Department of Pharmacology and Toxicology , Charles University, Faculty of Pharmacy in Hradec Kralove , Akademika Heyrovskeho 1203 , 50005 Hradec Kralove , Czech Republic
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32
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Bozkurt M, Antonoff M, Jaramillo S, Sagebiel T, Murphy MB. Gastroesophageal Cancer During Pregnancy: a Case Report and Review of the Literature. J Gastrointest Cancer 2018; 50:634-640. [PMID: 29577180 DOI: 10.1007/s12029-018-0093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mustafa Bozkurt
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Sylvia Jaramillo
- Department of Hematology-Oncology, Texas Oncology, Austin, TX, 78758, USA
| | - Tara Sagebiel
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mariela B Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA. .,Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
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33
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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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Marwah S, Gaikwad HS, Mohindra R, Sharma M. Up the Duff With Non-Hodgkin's Lymphoma: The Traumas and the Dilemmas. J Clin Diagn Res 2017; 11:QD03-QD05. [PMID: 28384939 DOI: 10.7860/jcdr/2017/23972.9221] [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: 09/06/2016] [Accepted: 11/04/2016] [Indexed: 11/24/2022]
Abstract
Lymphoma is fourth most frequent malignancy diagnosed prenatally (~1:6000 cases), with Hodgkin's Lymphoma (HL) forming the major chunk. However, in recent times, there has been an increase in occurrence of Non-Hodgkin's Lymphoma (NHL) due to late child bearing age and high incidence of AIDS-related NHL in developing countries. Managing NHL in pregnancy involves intricate medical, ethical and psychological issues. Diagnostic and treatment delays may influence the prognosis for indolent cases. Seen the complexity of the management decisions associated with NHL, interdisciplinary and individualized approach becomes imperative for each woman. We present a case of 25-year-old G2P0010 at 32 weeks Period of Gestation (PoG) with right sided deep cervical lymphadenopathy, who was diagnosed as aggressive malignant NHL and was subsequently started on chemotherapy after confirmation of diagnosis and eventually had an optimal feto-maternal outcome. The critical appraisal of the accessible data, identification of controversies and unresolved issues and proposal of elucidations about varied facets of NHL in pregnancy are also provided.
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Affiliation(s)
- Sheeba Marwah
- Research Officer, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital , New Delhi, India
| | - Harsha Shailesh Gaikwad
- Professor, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital , New Delhi, India
| | - Ritin Mohindra
- Senior Resident, Department of Internal Medicine, VMMC and Safdarjung Hospital , New Delhi, India
| | - Manjula Sharma
- Professor and Consultant, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital , New Delhi, India
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Garofalo S, Degennaro V, Salvi S, De Carolis M, Capelli G, Ferrazzani S, De Carolis S, Lanzone A. Perinatal outcome in pregnant women with cancer: are there any effects of chemotherapy? Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 12/22/2022]
Affiliation(s)
- S. Garofalo
- High Risk Pregnancy Unit; Catholic University of Sacred Heart; Rome Italy
| | - V.A. Degennaro
- High Risk Pregnancy Unit; Catholic University of Sacred Heart; Rome Italy
| | - S. Salvi
- High Risk Pregnancy Unit; Catholic University of Sacred Heart; Rome Italy
| | - M.P. De Carolis
- Division of Neonatology; Department of Pediatrics; Catholic University of Sacred Heart; Rome Italy
| | - G. Capelli
- Department of Hygiene; University of Cassino; Cassino Italy
| | - S. Ferrazzani
- High Risk Pregnancy Unit; Catholic University of Sacred Heart; Rome Italy
| | - S. De Carolis
- High Risk Pregnancy Unit; Catholic University of Sacred Heart; Rome Italy
| | - A. Lanzone
- High Risk Pregnancy Unit; Catholic University of Sacred Heart; Rome Italy
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Lorenzi E, Simonelli M, Santoro A. Infertility risk and teratogenicity of molecularly targeted anticancer therapy: A challenging issue. Crit Rev Oncol Hematol 2016; 107:1-13. [PMID: 27823636 DOI: 10.1016/j.critrevonc.2016.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/20/2016] [Accepted: 08/16/2016] [Indexed: 01/06/2023] Open
Abstract
The growing population of young cancer survivors and a trend toward postponing pregnancy until later in life are shifting areas of focus toward understanding treatment induced sequelae, particularly the effects of cancer and/or treatment on fertility. Whereas the fertility risk of cytotoxic agents for both men and women is well-recognized, the fertility risks and teratogenic potential associated with molecular targeted therapies are not established. We summarize available preclinical and clinical data on the impact of new molecular targeted agents on fertility in both sexes, and their potential teratogenic effects, providing recommendations for clinicians, where possible. Agents were categorized by class and the potential relevance of their target signaling pathways to gonadal maturation discussed.
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Affiliation(s)
- Elena Lorenzi
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Mi), Italy.
| | - Matteo Simonelli
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Armando Santoro
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Mi), Italy; Humanitas University, Rozzano Milan, Italy
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Aytac E, Ozuner G, Isik O, Gorgun E, Stocchi L. Management of colorectal neoplasia during pregnancy and in the postpartum period. World J Gastrointest Oncol 2016; 8:550-554. [PMID: 27559434 PMCID: PMC4942743 DOI: 10.4251/wjgo.v8.i7.550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/09/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To report our experience on management of colorectal neoplasia during pregnancy and in the postpartum period.
METHODS: Patients who were diagnosed with colorectal cancer during pregnancy or in the postpartum period (< 6 mo), between 8/1997 and 4/2013, in our department were reviewed. Patient characteristics, operations, fetal health and follow-up during pregnancy, type of delivery and oncologic outcomes were analyzed.
RESULTS: Eight patients met our study criteria. Median age at the time of diagnosis of colorectal cancer was 31 years. Median follow-up after surgery was 36 mo. Median duration of symptoms before diagnosis was 16 wk. Three patients were diagnosed with colorectal cancer during pregnancy and underwent surgery prior to delivery. None of the patients received adjuvant treatment during pregnancy. Five patients were diagnosed with colorectal cancer within a median of 2.1 mo after delivery and underwent surgery. No adverse neonatal outcomes were noted. All deliveries were at term (2 cesarean sections) except for one preterm delivery following low anterior resection on the 34th week of pregnancy.
CONCLUSION: There has been a significant delay in the diagnosis of colorectal cancer which is probably due to overlap of symptoms and signs between these tumors and a normal pregnancy. Surgery for colorectal cancer during pregnancy can be performed safely without compromising maternal and fetal outcomes.
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Zarkavelis G, Petrakis D, Fotopoulos G, Mitrou S, Pavlidis N. Bone and soft tissue sarcomas during pregnancy: A narrative review of the literature. J Adv Res 2016; 7:581-7. [PMID: 27408761 PMCID: PMC4921935 DOI: 10.1016/j.jare.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/18/2022] Open
Abstract
Bone or soft tissue sarcomas are rarely diagnosed during pregnancy. Until today 137 well documented cases have been reported in the English literature between 1963 and 2014. Thirty-eight pregnant mothers were diagnosed with osteosarcoma, Ewing's sarcoma or chondrosarcoma, whereas 95 other cases of soft tissue sarcomas of various types have been documented. We present the clinical picture and therapeutic management of this coexistence.
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Affiliation(s)
- George Zarkavelis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
| | - Dimitrios Petrakis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
| | - George Fotopoulos
- Department of Medicine, Sotiria General Hospital, Athens University, Athens, Greece
| | - Sotirios Mitrou
- REA Maternity Hospital, A. Sygrou Avenue, 383, P. Faliro, Athens, Greece
| | - Nicholas Pavlidis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
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Khaled H, Lahloubi NA, Rashad N. Review on renal cell carcinoma and pregnancy: A challenging situation. J Adv Res 2016; 7:575-80. [PMID: 27408760 PMCID: PMC4921780 DOI: 10.1016/j.jare.2016.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 12/15/2022] Open
Abstract
Renal cell carcinoma is rarely diagnosed during pregnancy. Its management is a real challenge due to the sparse literature and lack of standard guidelines. In this situation, the diagnosis is often delayed as the clinical presentation might resemble other pregnancy-related disorders but it should be one of the diagnostic possibilities in women with recurrent or refractory urinary tract symptoms, renal pain, or mass that could be palpated. Diagnostic approach may include ultrasound examination and sometimes magnetic resonance imaging. If localized, surgery would be the preferred line of treatment. Other treatment modalities, end results of treatment, and review of literature of this rare association will be presented.
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Affiliation(s)
- Hussein Khaled
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
| | - Nasr Al Lahloubi
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
| | - Noha Rashad
- Department of Medical Oncology, Military Armed Hospital Caner Center, Cairo, Egypt
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Miyamoto S, Yamada M, Kasai Y, Miyauchi A, Andoh K. Anticancer drugs during pregnancy. Jpn J Clin Oncol 2016; 46:795-804. [PMID: 27284093 DOI: 10.1093/jjco/hyw073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/17/2016] [Indexed: 11/12/2022] Open
Abstract
Although cancer diagnoses during pregnancy are rare, they have been increasing with the rise in maternal age and are now a topic of international concern. In some cases, the administration of chemotherapy is unavoidable, though there is a relative paucity of evidence regarding the administration of anticancer drugs during pregnancy. As more cases have gradually accumulated and further research has been conducted, we are beginning to elucidate the appropriate timing for the administration of chemotherapy, the regimens that can be administered with relative safety, various drug options and the effects of these drugs on both the mother and fetus. However, new challenges have arisen, such as the effects of novel anticancer drugs and the desire to bear children during chemotherapy. In this review, we outline the effects of administering cytotoxic anticancer drugs and molecular targeted drugs to pregnant women on both the mother and fetus, as well as the issues regarding patients who desire to bear children while being treated with anticancer drugs.
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Affiliation(s)
- Shingo Miyamoto
- Department of Medical Oncology, Japanese Red Cross Medical Center, Shibuya, Tokyo
| | - Manabu Yamada
- Department of Gynecology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Yasuyo Kasai
- Department of Gynecology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Akito Miyauchi
- Department of Gynecology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Kazumichi Andoh
- Department of Gynecology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
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Zagouri F, Dimitrakakis C, Marinopoulos S, Tsigginou A, Dimopoulos MA. Cancer in pregnancy: disentangling treatment modalities. ESMO Open 2016; 1:e000016. [PMID: 27843602 PMCID: PMC5070264 DOI: 10.1136/esmoopen-2015-000016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 01/25/2023] Open
Abstract
Pregnancy-associated cancer constitutes an uncommon and difficult to manage clinical situation. It is defined as the cancer diagnosed from the first day of childbearing to 1 year post partum. Coexistence of cancer with pregnancy adds complexity to treatment recommendations, as both the mother and the fetus may be affected. The optimal therapeutic management of pregnant women with cancer diagnosis should take into account, apart from medical factors, a host of other parameters (ethical, psychological, religious, legal, etc). Unfortunately, this situation becomes more complex as more women delay childbearing, and consequently the incidence of cancer during pregnancy is constantly increasing. This manuscript summarises the general principles in managing pregnant patients with cancer and gives detailed instructions in the management of pregnant patients with breast cancer, ovarian cancer, melanoma, lymphoma, lung cancer, soft-tissue sarcoma and cervical cancer. Of note, management of pregnant women with cancer diagnosis should be performed in specialised centres with experience and all cases should be discussed in multidisciplinary meetings composed of multiple specialists (medical oncologists, obstetricians, surgeons, radiologists and paediatricians).
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Constantine Dimitrakakis
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Spyridon Marinopoulos
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Alexandra Tsigginou
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Meletios-Athanassios Dimopoulos
- Department of Clinical Therapeutics , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
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42
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Ngu SF, Ngan HY. Chemotherapy in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:86-101. [DOI: 10.1016/j.bpobgyn.2015.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/09/2015] [Indexed: 01/06/2023]
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43
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Mukhopadhyay A, Shinde A, Naik R. Ovarian cysts and cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:58-72. [DOI: 10.1016/j.bpobgyn.2015.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/27/2022]
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44
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A mini review on pregnant mothers with cancer: A paradoxical coexistence. J Adv Res 2016; 7:559-63. [PMID: 27408757 PMCID: PMC4921772 DOI: 10.1016/j.jare.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/29/2016] [Accepted: 01/30/2016] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of cancer during pregnancy at least in the Western world is a rare phenomenon, but this might be raised into the future due to late pregnancies in the modern societies. The coexistence of pregnancy and cancer implicates numerous medical, ethical, psychological and sometimes religious issues between the mother, the family and the treating physician. Breast, cervical cancer, melanoma and lymphoma are the most common malignancies diagnosed during pregnancy. Diagnostic or therapeutic irradiation requires careful application, whereas systemic chemotherapy is not allowed during the first trimester of pregnancy due to lethal or teratogenic effects as well as to congenital malformations. In some gestational cancers, tumor cells can invade the placenta or the fetus.
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Abstract
The diagnosis of lung cancer in pregnancy is rare. Most cases are quite advanced and have dismal outcomes despite treatment. We present the case of a 26-year-old woman who was diagnosed with Stage IIIA (T3N2M0) squamous-cell carcinoma of the lung with lymphoepithelioma-like features at the 18(th) week of pregnancy. A chest CT revealed a large right hilar mass with obliteration of the right main bronchus and resulting collapse of the right lung with mediastinal shift to the right. A transbronchial biopsy of the mass and a subcarinal lymph node confirmed poorly differentiated squamous cell carcinoma with lymphoepithelioma-like features. Brain MRI, PET, and CT scans were negative for distant metastasis. The patient received four cycles of neoadjuvant cisplatin and docetaxel with a complete radiographic response. She delivered a healthy baby girl at 35 weeks gestation. Post-partum, she received radiation to the right hilum and mediastinum as consolidation. The patient continues to remain free of disease more than 16 months after initial diagnosis. To our knowledge, this is the only reported case of lung cancer in pregnancy where there is a complete response to chemotherapy. The histology is also distinct from other reported cases. In addition, this case exemplifies the relative safety and efficacy of chemotherapy during the later stages of pregnancy. As long as a patient is beyond the first trimester of pregnancy, platinum-based doublet chemotherapy may be considered as a feasible treatment option.
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Affiliation(s)
| | - Jun Zhang
- Medicine, Baylor College of Medicine
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46
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Mitrou S, Petrakis D, Fotopoulos G, Zarkavelis G, Pavlidis N. Lung cancer during pregnancy: A narrative review. J Adv Res 2015; 7:571-4. [PMID: 27408759 PMCID: PMC4921954 DOI: 10.1016/j.jare.2015.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 02/01/2023] Open
Abstract
Lung cancer, the leading cause of cancer deaths in males for decades, has recently become one of commonest causes for women too. As women delay the start of their family, the co-existence of cancer and pregnancy is increasingly observed. Nevertheless, lung cancer during pregnancy remains a rather uncommon condition with less than 70 cases published in recent years. Non-small cell lung carcinoma is the commonest type accounting for about 85% of all cases. Overall survival rates are low. Chemotherapy and/or targeted treatment have been used with poor outcomes. The disease has been also found to affect the products of conception with no short- or long-term consequences for the neonate. This article is referring to a narrative review of lung cancers diagnosed in pregnant women around the world.
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Affiliation(s)
- Sotirios Mitrou
- Rea Maternity Hospital, A. Sygrou Avenue 383, P. Faliro, Athens, Greece
| | - Dimitrios Petrakis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - George Fotopoulos
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - George Zarkavelis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - Nicholas Pavlidis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
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Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence. J Occup Environ Med 2015; 56:901-10. [PMID: 25153300 DOI: 10.1097/jom.0000000000000249] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Antineoplastic drugs are known reproductive and developmental toxicants. Our objective was to review the existing literature of reproductive health risks to workers who handle antineoplastic drugs. METHODS A structured literature review of 18 peer-reviewed, English language publications of occupational exposure and reproductive outcomes was performed. RESULTS Although effect sizes varied with study size and population, occupational exposure to antineoplastic drugs seems to raise the risk of both congenital malformations and miscarriage. Studies of infertility and time to pregnancy also suggested an increased risk for subfertility. CONCLUSIONS Antineoplastic drugs are highly toxic in patients receiving treatment, and adverse reproductive effects have been well documented in these patients. Health care workers with long-term, low-level occupational exposure to these drugs also seem to have an increased risk of adverse reproductive outcomes. Additional precautions to prevent exposure should be considered.
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Lambertini M, Kamal NS, Peccatori FA, Del Mastro L, Azim HA. Exploring the safety of chemotherapy for treating breast cancer during pregnancy. Expert Opin Drug Saf 2015; 14:1395-408. [DOI: 10.1517/14740338.2015.1061500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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49
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Postl LK, Gradl G, von Eisenhart-Rothe R, Toepfer A, Pohlig F, Burgkart R, Rechl H, Kirchhoff C. Management of musculoskeletal tumors during pregnancy: a retrospective study. BMC WOMENS HEALTH 2015; 15:48. [PMID: 26059904 PMCID: PMC4462116 DOI: 10.1186/s12905-015-0204-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/26/2015] [Indexed: 12/03/2022]
Abstract
Background In recent years, scientific research has increasingly focused on malignancies during pregnancy. However, the development of musculoskeletal tumors during pregnancy has only been the subject of a few studies so far. The primary aim of this study was to identify the incidence of sarcomas during pregnancy at our musculoskeletal tumor center (MSTC). Secondarily we intended to analyze these cases and discuss possible recommendations regarding diagnostic work-up as well as therapy on the basis of the literature. Methods All female patients who had been treated for soft tissue or bone sarcoma at our academic MSTC in the period between the years 2002 and 2010 were screened retrospectively for anamnestic annotations of pregnancy or records of pregnancy in the obstetrical database of our university hospital. The patients who met the criteria for inclusion (diagnosed sarcoma and pregnancy) were enrolled. For every pregnant patient two age-matched female control patients that suffered from tumors with the same histologic type were included. Results In the period between 2002 and 2010, 240 female patients between the age of 16 and 45 were treated for sarcoma. In eight out of the 240 cases the tumor disease developed or progressed during pregnancy. The delay in diagnosis was approximately eight months and turned out to be significantly higher for pregnant patients compared to non- pregnant controls. Each woman’s tumor was misdiagnosed at least once. Conclusions Diagnostic follow-up of pregnant women presenting with a growing or painful mass, which is suspected to be a musculoskeletal tumor, should be performed at a specialized tumor center. We recommend a multidisciplinary approach and discussing all possible consequences for mother and child intensively in accordance with the available literature.
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Affiliation(s)
- Lukas K Postl
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Guntmar Gradl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Andreas Toepfer
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Rainer Burgkart
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Hans Rechl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany.
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Evans AC, Nelson MB, Dhall G. Pregnancy in a Patient With a Malignant Brain Tumor Taking Temozolomide. J Pediatr Oncol Nurs 2015; 32:326-8. [DOI: 10.1177/1043454214563414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Temozolomide (TMZ), an alkylating agent used in the treatment of malignant gliomas, is a pregnancy category D medication that is not advised for use in pregnant women. We report the case of a 19-year-old woman with anaplastic oligodendroglioma (high-grade glioma) who became pregnant during maintenance chemotherapy consisting of TMZ 200 mg/m2 administered 5 days monthly. The TMZ was immediately discontinued after she developed a positive pregnancy test. She delivered a full-term healthy baby boy with no prenatal or perinatal complications. Adolescents and young adults with brain tumors are often sexually active and should receive intensive and repeated anticipatory guidance regarding contraception while receiving chemotherapy. Pediatric oncology nurses are in a unique position to provide this education for patients and ensure that young women have appropriate pregnancy testing prior to chemotherapy administration.
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Affiliation(s)
- Anna C. Evans
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Girish Dhall
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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