1
|
Struys I, Velázquez C, Devriendt K, Godderis L, Segers H, Thienpont B, van Boxtel R, Van Calsteren K, Voet T, Wolters V, Lenaerts L, Amant F. Evaluating offspring Genomic and Epigenomic alterations after prenatal exposure to Cancer treatment In Pregnancy (GE-CIP): a multicentric observational study. BMJ Open 2024; 14:e081833. [PMID: 38548357 PMCID: PMC10982724 DOI: 10.1136/bmjopen-2023-081833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Around 1 in 1000-2000 pregnancies are affected by a cancer diagnosis. Previous studies have shown that chemotherapy during pregnancy has reassuring cognitive and cardiac neonatal outcomes, and hence has been proposed as standard of care. However, although these children perform within normal ranges for their age, subtle differences have been identified. Given that chemotherapeutic compounds can cross the placenta, the possibility that prenatal chemotherapy exposure mutates the offspring's genome and/or epigenome, with potential deleterious effects later in life, urges to be investigated. METHODS AND ANALYSES This multicentric observational study aims to collect cord blood, meconium and neonatal buccal cells at birth, as well as peripheral blood, buccal cells and urine from infants when 6, 18 and/or 36 months of age. Using bulk and single-cell approaches, we will compare samples from chemotherapy-treated pregnant patients with cancer, pregnant patients with cancer not treated with chemotherapy and healthy pregnant women. Potential chemotherapy-related newborn genomic and/or epigenomic alterations, such as single nucleotide variants, copy number variants and DNA-methylation alterations, will be identified in mononuclear and epithelial cells, isolated from blood, buccal swabs and urine. DNA from maternal peripheral blood and paternal buccal cells will be used to determine de novo somatic mutations in the neonatal blood and epithelial cells. Additionally, the accumulated exposure of the fetus, and biological effective dose of alkylating agents, will be assessed in meconium and cord blood via mass spectrometry approaches. ETHICS AND DISSEMINATION The Ethics Committee Research of UZ/KU Leuven (EC Research) and the Medical Ethical Review Committee of University Medical Center Amsterdam have approved the study. Results of this study will be disseminated via presentations at (inter)national conferences, through peer-reviewed, open-access publications, via social media platforms aimed to inform patients and healthcare workers, and through the website of the International Network on Cancer, Infertility and Pregnancy (www.cancerinpregnancy.org).
Collapse
Affiliation(s)
- Ilana Struys
- Department of Oncology, KU Leuven, Leuven, Flanders, Belgium
| | | | - Koenraad Devriendt
- Department of Human Genetics, University Hospital Leuven, Leuven, Belgium
| | - Lode Godderis
- Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
- External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Heidi Segers
- Department of Paediatric Oncology, University Hospital Leuven, Leuven, Belgium
| | | | - Ruben van Boxtel
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - Thierry Voet
- Department of Human Genetics, KU Leuven, Leuven, Flanders, Belgium
- Institute for Single Cell Omics (LISCO), KU Leuven, Leuven, Flanders, Belgium
| | - Vera Wolters
- Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Frederic Amant
- Department of Oncology, KU Leuven, Leuven, Flanders, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
- Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| |
Collapse
|
2
|
Van Assche IA, Huis In 't Veld EA, Van Calsteren K, van Gerwen M, Blommaert J, Cardonick E, Halaska MJ, Fruscio R, Fumagalli M, Lemiere J, van Dijk-Lokkart EM, Fontana C, van Tinteren H, De Ridder J, van Grotel M, van den Heuvel-Eibrink MM, Lagae L, Amant F. Cognitive and Behavioral Development of 9-Year-Old Children After Maternal Cancer During Pregnancy: A Prospective Multicenter Cohort Study. J Clin Oncol 2023; 41:1527-1532. [PMID: 36634293 PMCID: PMC10022854 DOI: 10.1200/jco.22.02005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.This multicenter cohort study reports on the long-term effects of prenatal exposure to maternal cancer and its treatment on cognitive and behavioral outcomes in 9-year-old children. In total, 151 children (mean age, 9.3 years; range, 7.8-10.6 years) were assessed using a neurocognitive test battery and parent-report behavioral questionnaires. During pregnancy, 109 children (72.2%) were exposed to chemotherapy (only or in combination with other treatment modalities), 18 (11.9%) to surgery only, 16 (10.6%) to radiotherapy, one to trastuzumab, and 16 (10.6%) were not exposed to oncologic treatment. Mean cognitive and behavioral outcomes were within normal ranges. Gestational age at birth showed a positive association with Full Scale Intelligence Quotient (FSIQ), with the average FSIQ score increasing by 1.6 points for each week increase in gestational age (95% CI, 0.7 to 2.5; P < .001). No difference in FSIQ was found between treatment types (F[4,140] = 0.45, P = .776). In children prenatally exposed to chemotherapy, no associations were found between FSIQ and chemotherapeutic agent, exposure level, or timing during pregnancy. These results indicate a reassuring follow-up during the critical maturational period of late childhood, when complex functions develop and rely on the integrity of early brain development. However, associations were observed with preterm birth, maternal death, and maternal education.
Collapse
Affiliation(s)
- Indra A Van Assche
- Department of Development and Regeneration, Unit of Woman and Child, KU Leuven, Belgium
| | - Evangeline A Huis In 't Veld
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Center for Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kristel Van Calsteren
- Department of Development and Regeneration, Unit of Woman and Child, KU Leuven, Belgium.,Division of Foetomaternal Medicine, Department of Obstetrics and Gynaecology, UZ Leuven, Belgium
| | - Mathilde van Gerwen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Center for Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jeroen Blommaert
- Department of Oncology, Unit of Pediatric Oncology, KU Leuven, Belgium.,Department of Oncology, Unit of Gynaecological Oncology, KU Leuven, Belgium.,Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Belgium
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ
| | - Michael J Halaska
- Department of Obstetric Gynecology, University Hospital Kralovske Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Robert Fruscio
- Department of Medicine and Surgery, Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milano, Italy
| | - Jurgen Lemiere
- Department of Oncology, Unit of Pediatric Oncology, KU Leuven, Belgium.,Division of Pediatric Hemato-Oncology, Department of Pediatrics, UZ Leuven, Belgium
| | - Elisabeth M van Dijk-Lokkart
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam, the Netherlands.,Amsterdam Reproduction and Development, Child Development, Amsterdam, the Netherlands
| | - Camilla Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milano, Italy
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jessie De Ridder
- Division of Pediatric Neurology, Department of Pediatrics, UZ Leuven, Belgium.,Department of Development and Regeneration, Unit Locomotor and Neurological Disorders, KU Leuven, Belgium
| | | | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,UMCU-Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Lieven Lagae
- Department of Development and Regeneration, Unit of Woman and Child, KU Leuven, Belgium.,Division of Pediatric Neurology, Department of Pediatrics, UZ Leuven, Belgium
| | - Frédéric Amant
- Center for Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oncology, Unit of Gynaecological Oncology, KU Leuven, Belgium.,Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, UZ Leuven, Belgium
| |
Collapse
|
3
|
DiPiero M, Rodrigues PG, Gromala A, Dean DC. Applications of advanced diffusion MRI in early brain development: a comprehensive review. Brain Struct Funct 2023; 228:367-392. [PMID: 36585970 PMCID: PMC9974794 DOI: 10.1007/s00429-022-02605-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
Brain development follows a protracted developmental timeline with foundational processes of neurodevelopment occurring from the third trimester of gestation into the first decade of life. Defining structural maturational patterns of early brain development is a critical step in detecting divergent developmental trajectories associated with neurodevelopmental and psychiatric disorders that arise later in life. While considerable advancements have already been made in diffusion magnetic resonance imaging (dMRI) for pediatric research over the past three decades, the field of neurodevelopment is still in its infancy with remarkable scientific and clinical potential. This comprehensive review evaluates the application, findings, and limitations of advanced dMRI methods beyond diffusion tensor imaging, including diffusion kurtosis imaging (DKI), constrained spherical deconvolution (CSD), neurite orientation dispersion and density imaging (NODDI) and composite hindered and restricted model of diffusion (CHARMED) to quantify the rapid and dynamic changes supporting the underlying microstructural architectural foundations of the brain in early life.
Collapse
Affiliation(s)
- Marissa DiPiero
- Department of Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | | | - Alyssa Gromala
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53705, USA.
| |
Collapse
|
4
|
Van Assche IA, Lemiere J, Amant F, Van Calsteren K. Direct and indirect effects on child neurocognitive development when maternal cancer is diagnosed during pregnancy: What do we know so far? Crit Rev Oncol Hematol 2022; 179:103824. [PMID: 36174901 DOI: 10.1016/j.critrevonc.2022.103824] [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: 08/29/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
Cancer during pregnancy threatens the lives of mother and foetus and its incidence is rising, making it an emerging medical challenge. Evidence on the direct impact of cancer therapies on neonatal outcomes resulted in general guidelines for maternal treatment that safeguards foetal development. Less focus has been placed on indirect factors, in pre- and postnatal periods, that may exert long-term impacts specifically on child neurocognition. Foetal development, in the context of maternal cancer during pregnancy, may be influenced directly by exposure to cancer diagnostics and (co-)treatment, or indirectly through maternal inflammation, malnutrition, hormonal fluctuations, prematurity, and psycho-biological stress. Maternal stress and insecure mother-infant bonding related to postpartum cancer treatment may further impact child cognitive-behavioural development. Understanding the independent and synergistic effects of the factors impacting neurocognitive development creates the opportunity to intervene during the oncological treatment to improve the child's long-term outcome, both by medical and psychosocial care and support.
Collapse
Affiliation(s)
- Indra A Van Assche
- Department of Development and Regeneration: Woman and Child, KU Leuven, Belgium.
| | - Jurgen Lemiere
- Department of Oncology: Pediatric Oncology, KU Leuven, Belgium; Department of Pediatrics: Pediatric Hemato-Oncology, University Hospitals Leuven, Belgium.
| | - Frédéric Amant
- Department of Oncology: Gynaecological Oncology, KU Leuven, Belgium; Department of Obstetrics and Gynaecology: Gynaecological Oncology, University Hospitals Leuven, Belgium; Center for Gynaecologic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Kristel Van Calsteren
- Department of Development and Regeneration: Woman and Child, KU Leuven, Belgium; Department of Obstetrics and Gynaecology: Foetomaternal Medicine, University Hospitals Leuven, Belgium.
| |
Collapse
|
5
|
Bolon B, Dostal LA, Garman RH. Neuropathology Evaluation in Juvenile Toxicity Studies in Rodents: Comparison of Developmental Neurotoxicity Studies for Chemicals With Juvenile Animal Studies for Pediatric Pharmaceuticals. Toxicol Pathol 2021; 49:1405-1415. [PMID: 34620000 DOI: 10.1177/01926233211045321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The developmental neuropathology examination in juvenile toxicity studies depends on the nature of the product candidate, its intended use, and the exposure scenario (eg, dose, duration, and route). Expectations for sampling, processing, and evaluating neural tissues differ for developmental neurotoxicity studies (DNTS) for chemicals and juvenile animal studies (JAS) for pediatric pharmaceuticals. Juvenile toxicity studies typically include macroscopic observations, brain weights, and light microscopic evaluation of routine hematoxylin and eosin (H&E)-stained sections from major neural tissues (brain, spinal cord, and sciatic nerve) as neuropathology endpoints. The DNTS is a focused evaluation of the nervous system, so the study design incorporates perfusion fixation, plastic embedding of at least one nerve, quantitative analysis of selected brain regions, and sometimes special neurohistological stains. In contrast, the JAS examines multiple systems, so neural tissues undergo conventional tissue processing (eg, immersion fixation, paraffin embedding, H&E staining only). An "expanded neurohistopathology" (or "expanded neuropathology") approach may be performed for JAS if warranted, typically by light microscopic evaluation of more neural tissues (usually additional sections of brain, ganglia, and/or more nerves) or/and special neurohistological stains, to investigate specific questions (eg, a more detailed exploration of a potential neuroactive effect) or to fulfill regulatory requests.
Collapse
|
6
|
Struys I, Lenaerts L, Thienpont B, Amant F. Novel next-generation sequencing-based methodologies to characterize the mutational consequences of (prenatal) chemotherapy exposure in noncancerous tissue. Curr Opin Oncol 2021; 33:476-484. [PMID: 34038918 DOI: 10.1097/cco.0000000000000755] [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: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although chemotherapeutics are considered as genotoxins for decades, their exact mutagenic impact on the genome of cancerous and normal cells of cancer patients was unknown for a long time. However, this knowledge is necessary to understand the long-term side effects of chemotherapy. A particular condition represents pregnant cancer patients being treated with chemotherapy. Since certain chemotherapeutics can cross the placenta, concerns exist about possible mutational effects on the fetus' genome with potential long-term health consequences. RECENT FINDINGS Recent advances of next-generation sequencing (NGS) techniques have opened possibilities to explore the exact mutational footprint of chemotherapies in healthy tissue from treated cancer patients. However, the ultra-low frequency of chemotherapy-induced mutations, introduction of technical artefacts, and inaccessibility of normal tissue has posed important limitations. This review discusses five state-of-the-art approaches that were recently designed to overcome these drawbacks. SUMMARY Results of the latest investigations give valuable insights into the genome-wide genotoxicity profile of frequently applied chemotherapies, with most of these drugs being associated with a signature of random base substitutions and small indels. Though these findings still might be limited to extrapolate to healthy tissue, they pave the way for studies on the origin of long-term chemotherapy-related adverse health effects.
Collapse
Affiliation(s)
| | | | | | - Frédéric Amant
- Department of Oncology
- Gynecologic Oncology, Netherlands Cancer Institute
- Gynecologic Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Schwab R, Anic K, Hasenburg A. Cancer and Pregnancy: A Comprehensive Review. Cancers (Basel) 2021; 13:3048. [PMID: 34207252 PMCID: PMC8234287 DOI: 10.3390/cancers13123048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 01/11/2023] Open
Abstract
Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. Tumor entity, stage, biology and gestational week at diagnosis determine the appropriate approach. As premature delivery emerged as one of the main risk factors for adverse long-term outcome of the progeny, it should be avoided, if reasonable from the oncological perspective. This article offers a comprehensive review with respect to the various aspects of cancer in pregnancy.
Collapse
Affiliation(s)
- Roxana Schwab
- Department of Obstetrics and Women’s Health, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.A.); (A.H.)
| | | | | |
Collapse
|
8
|
Korakiti AM, Zografos E, van Gerwen M, Amant F, Dimopoulos MA, Zagouri F. Long-Term Neurodevelopmental Outcome of Children after in Utero Exposure to Chemotherapy. Cancers (Basel) 2020; 12:cancers12123623. [PMID: 33287323 PMCID: PMC7761755 DOI: 10.3390/cancers12123623] [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: 11/01/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Facing cancer diagnosis during pregnancy constitutes a truly complex and challenging situation for both the patients and the physicians. Cancer diagnosis in a period of hope and joy is an unendurable situation that may affect the psychosocial functioning of the mother, causing depression, anxiety, self-blame, and social isolation. At the same time, a moral dilemma evolves among medical professionals; what is best for the mother in terms of immediate chemotherapy may have detrimental effects on the fetus, and conversely, delaying therapy and protecting the fetus may have a negative impact on the mother as the tumor progresses. Solid data on the safety profile or risks of anti-cancer agents and on the long-term neurodevelopmental outcome of children after in utero exposure to chemotherapy may provide both the patients and the physicians the information necessary for shared decision making when cancer is diagnosed during pregnancy. Abstract Pregnancy-related cancer management represents a real challenge for both the patients and the physicians. The long-term neurodevelopmental outcome of children in utero exposed to chemotherapeutic agents has only recently been addressed. This review aims to systematically integrate and highlight all existing data from the literature regarding the effect of prenatal exposure to chemotherapy on fetal brain growth and child development. All eligible studies are based on validated neurodevelopmental testing scales (e.g., Bayley Scales of Infant Development, Wechsler Preschool and Primary Scale of Intelligence) and/or well-defined questionnaires. Our systematic review including 17 studies demonstrates that no major consequences on the neurodevelopment of children after in utero exposure to anti-cancer drugs have been reported; nevertheless, longer and more thorough follow-up with large-scale multicenter prospective studies is certainly required in order to draw firm conclusions.
Collapse
Affiliation(s)
- Anna-Maria Korakiti
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (E.Z.); (M.-A.D.)
| | - Eleni Zografos
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (E.Z.); (M.-A.D.)
| | - Mathilde van Gerwen
- Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands; (M.v.G.); (F.A.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Frédéric Amant
- Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands; (M.v.G.); (F.A.)
- Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Center for Gynecologic Oncology Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (E.Z.); (M.-A.D.)
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (E.Z.); (M.-A.D.)
- Correspondence:
| |
Collapse
|