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Florez N, Kaufman RA, Yáñez-Sarmiento A, Abioye O, Kiel LR. When the unimaginable happens: Lung cancer diagnosis during pregnancy. Cancer 2024; 130:1905-1909. [PMID: 38285618 DOI: 10.1002/cncr.35227] [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: 01/31/2024]
Abstract
The increasing incidence of lung cancer diagnosis during pregnancy has brought new challenges and opportunities to expand the knowledge gap in this protected patient population. Here, available data and top recommendations for the practicing oncologist are discussed.
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Affiliation(s)
- Narjust Florez
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rebekah A Kaufman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Oyepeju Abioye
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lauren R Kiel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Chadwick V, Kim M, Mills G, Tang C, Anazodo A, Dear R, Rodgers R, Lavee O, Milliken S, McCaughan G, Hamad N. A minority of women of childbearing potential are tested for pregnancy before chemoimmunotherapy: an Australian cancer centre experience. Intern Med J 2024; 54:750-754. [PMID: 37929784 DOI: 10.1111/imj.16287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Chemotherapy is potentially harmful to a developing foetus, and there are limited data on the foetal impact of chemoimmunotherapy (CIT). Therefore, determining pregnancy status prior to initiation of CIT should be standard of care. AIMS To determine how many women of childbearing age are tested for pregnancy prior to immunochemotherapy administration. METHODS A retrospective chart review at a large Australian metropolitan cancer referral centre, including 304 women aged 18-51 years with a diagnosis of cancer receiving outpatient-based CIT between 1 May 2015 and 12 June 2020. We assessed the uptake of pregnancy screening and contraception counselling prior to and during first-line CIT. RESULTS Only 17.3% of CIT cycles (n = 416) screened patients for pregnancy no more than 90 days prior to administration, and the median time between pregnancy screening and treatment was approximately 3 weeks. One patient with early breast cancer had a spontaneous miscarriage estimated at 3-4 weeks' gestation, and neither the patient nor the treating oncologist was aware of this event. This was also the only patient who had a pregnancy test beyond the first cycle of CIT during their treatment. CONCLUSIONS Our results highlight a concerningly low rate of pregnancy screening in women of childbearing age receiving CIT. The implication of missing a positive pregnancy test in this group of women could result in foetal complications, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. This highlights the urgent need for guidelines to mandate pregnancy testing in women of childbearing age receiving CIT and evidence-based implementation tools.
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Affiliation(s)
- Verity Chadwick
- Women's and Babies Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michaela Kim
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgia Mills
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Catherine Tang
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, New South Wales, Australia
| | - Antoinette Anazodo
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Rachel Dear
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Oncology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Rachael Rodgers
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Reproductive Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Orly Lavee
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sam Milliken
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
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Marks J, Sridhar A, Ai A, Kiel L, Kaufman R, Abioye O, Mantz C, Florez N. Precision Immuno-Oncology in NSCLC through Gender Equity Lenses. Cancers (Basel) 2024; 16:1413. [PMID: 38611091 PMCID: PMC11010825 DOI: 10.3390/cancers16071413] [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: 03/07/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Precision immuno-oncology involves the development of personalized cancer treatments that are influenced by the unique nature of an individual's DNA, immune cells, and their tumor's molecular characterization. Biological sex influences immunity; females typically mount stronger innate and adaptive immune responses than males. Though more research is warranted, we continue to observe an enhanced benefit for females with lung cancer when treated with combination chemoimmunotherapy in contrast to the preferred approach of utilizing immunotherapy alone in men. Despite the observed sex differences in response to treatments, women remain underrepresented in oncology clinical trials, largely as a result of gender-biased misconceptions. Such exclusion has resulted in the development of less efficacious treatment guidelines and clinical recommendations and has created a knowledge gap in regard to immunotherapy-related survivorship issues such as fertility. To develop a more precise approach to care and overcome the exclusion of women from clinical trials, flexible trial schedules, multilingual communication strategies, financial, and transportation assistance for participants should be adopted. The impact of intersectionality and other determinants of health that affect the diagnosis, treatment, and outcomes in women must also be considered in order to develop a comprehensive understanding of the unique impact of immunotherapy in all women with lung cancer.
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Affiliation(s)
- Jennifer Marks
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA;
| | | | - Angela Ai
- Olive View-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Lauren Kiel
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Rebekah Kaufman
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Oyepeju Abioye
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Courtney Mantz
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
- Harvard Medical School, Boston, MA 02115, USA
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Babkova A, Rob L, Kubecova M, Hruda M, Halaska MJ. Middle cerebral artery peak systolic velocity monitoring of fetal anemia during chemotherapy in pregnancy. Acta Obstet Gynecol Scand 2024; 103:660-668. [PMID: 38226422 PMCID: PMC10993339 DOI: 10.1111/aogs.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Chemotherapy during pregnancy can increase the risk of fetal anemia. Severe fetal anemia can lead to the development of hydrops fetalis and potentially fetal demise. Hence, it is imperative to implement consistent monitoring methods in the context of chemotherapy treatment. This study aimed to diagnose and monitor fetal anemia using middle cerebral artery peak systolic velocity (MCA-PSV) as a diagnostic tool during chemotherapy in pregnant women. MATERIAL AND METHODS The study employed a prospective analysis involving a case series of 15 patients diagnosed with cancer during pregnancy and subsequently underwent chemotherapy. MCA-PSV was used to identify fetal anemia. The patients were scheduled for ultrasound examinations of the MCA-PSV. The first examination was performed on the same day as the administration of chemotherapy, while the second occurred on the 10th day after chemotherapy. The measurement technique used in the study was based on the methodology proposed by Mari and Barr. The multiples of the median were calculated using the calculators provided by Medicina Fetal Barcelona. Based on these values anemia severity was determined. When moderate or severe anemia was identified, chemotherapy was individually modified. Additionally, a blood count analysis was conducted immediately after the delivery of the newborn. RESULTS Five patients were diagnosed with fetal or newborn anemia. With MCA-PSV, we identified moderate fetal anemia in two patients and severe fetal anemia in one. The complete blood count testing of newborns revealed mild anemia in three patients. One case was unrelated to chemotherapy-induced anemia. During treatment, fetal anemia did not corelate with maternal anemia. CONCLUSIONS In four cases of anemia the combination of cisplatin and iphosphamide was used as a chemotherapy agent. No anemia was observed in other drug combinations. Our findings suggest that MCA-PSV is a reliable method for identifying anemia and should be included in the treatment protocol for chemotherapy-induced fetal anemia.
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Affiliation(s)
- Anna Babkova
- Department of Obstetrics and GynecologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
| | - Lukas Rob
- Department of Obstetrics and GynecologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
| | - Martina Kubecova
- Department of OncologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
| | - Martin Hruda
- Department of Obstetrics and GynecologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
| | - Michael J. Halaska
- Department of Obstetrics and GynecologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
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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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Capozza MA, Romano A, Mastrangelo S, Attinà G, Maurizi P, Costa S, Vento G, Scambia G, Ruggiero A. Neonatal outcomes and follow-up of children born to women with pregnancy-associated cancer: a prospective observational study. BMC Pregnancy Childbirth 2024; 24:24. [PMID: 38172776 PMCID: PMC10763329 DOI: 10.1186/s12884-023-06182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND During the last decade, there has been a growing number of cases of children born from pregnancy-associated cancer (PAC), however there are currently insufficient data on the follow up to be observed in this category of newborns. Objective of the study was to evaluate the neonatal outcomes of infants born to mother with PAC, the potential adverse effect of chemotherapy during pregnancy and the risk of metastasis to the fetus. METHODS Maternal clinical data and neonatal outcomes of child born to mothers diagnosed with PAC were collected; infants were divided into those were and were not exposed to chemotherapy during fetal life and their outcomes were compered. RESULTS A total of 37 newborn infants from 36 women with PAC were analyzed. Preterm delivery occurred in 83.8% of the cases. No significant differences in neonatal outcomes were found between infants who were and were not exposed to chemotherapy during pregnancy. The median follow-up period was 12 months. CONCLUSIONS PAC treatment during the second or third trimester does not seem to be dangerous for the fetus, however infants born from PAC must be carefully evaluated for to rule out the consequences of chemotherapy and exclude the presence of metastasis. Long-term follow-up, especially in children exposed to chemotherapy, should be encouraged to obtain relevant data on long-term toxicity.
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Affiliation(s)
- Michele Antonio Capozza
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simonetta Costa
- Neonatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
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Arup G, Shravan N. Cancer and Pregnancy in the Post-Roe v. Wade Era: A Comprehensive Review. Curr Oncol 2023; 30:9448-9457. [PMID: 37999104 PMCID: PMC10669942 DOI: 10.3390/curroncol30110684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Cancer during pregnancy, affecting 1 in 1000 pregnancies, is rising in incidence due to delayed childbearing and improved detection. Common types include breast cancer, melanoma and cervical cancer and Hodgkin's Lymphoma. There are several physiological changes that occur during pregnancy that make its management a challenge to clinicians. Managing it requires multidisciplinary approaches and cautious test interpretation due to overlapping symptoms. To minimize fetal radiation exposure, non-ionizing imaging is preferred, and the interpretation of tumor markers is challenging due to inflammation and pregnancy effects. In terms of treatment, chemotherapy is avoided in the first trimester but may be considered later. Immunotherapy's safety is under investigation, and surgery depends on gestational age and cancer type. Ethical and legal concerns are growing, especially with changes in U.S. abortion laws. Access to abortion for medical reasons is vital for pregnant cancer patients needing urgent treatment. Maternal outcomes may depend on the type of cancer as well as chemotherapy received but, in general, they are similar to the non-pregnant population. Fetal outcomes are usually the same as the general population with treatment exposure from the second trimester onwards. Fertility preservation may be an important component of the treatment discussion depending on the patient's wishes, age and type of treatment. This article addresses the complicated nature of a diagnosis of cancer in pregnancy, touching upon the known medical literature as well as the ethical-legal implications of such a diagnosis, whose importance has increased in the light of recent judicial developments.
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Affiliation(s)
- Ganguly Arup
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Narmala Shravan
- Department of Hematology and Oncology, DHR Health Oncology Institute, Edinburg, TX 78539, 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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Houlihan OA, Buckley D, Maher GM, McCarthy FP, Khashan AS. Maternal and perinatal outcomes following a diagnosis of Hodgkin lymphoma during or prior to pregnancy: A systematic review. BJOG 2023; 130:336-347. [PMID: 36424902 PMCID: PMC10107208 DOI: 10.1111/1471-0528.17347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The initial peak incidence of Hodgkin lymphoma (HL) occurs during reproductive years. OBJECTIVES Synthesise published literature on the relationship between HL and maternal and perinatal outcomes. SEARCH STRATEGY Systematic search of PubMed/Medline, Cochrane Library, Scopus, Embase and Science Direct from inception to June 2022, supplemented by hand-searching reference lists. SELECTION CRITERIA Two reviewers independently reviewed titles, abstracts and full-text articles. Published studies containing original data were eligible. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and appraised study quality. Outcomes for pregnant women with a previous/current diagnosis of HL were compared separately with women never diagnosed with HL. Where data permitted, meta-analyses of odds ratios and proportions were performed. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. MAIN RESULTS Of the 5527 studies identified, 33 met the inclusion criteria. In the groups with HL before pregnancy and HL during pregnancy, adjusted odds ratios were not statistically significant for congenital malformation (aOR 1.7, 95% CI 0.9-3.1, and aOR 1.84, 95% CI 0.81-4.15, respectively), preterm birth (PTB) (aOR 0.99, 95% CI 0.65-1.51, and aOR 6.74, 95% CI 0.52-88.03, respectively) and miscarriage (aOR 0.78, 95% CI 0.55-1.10, and aOR 0.38, 95% CI 0.05-2.72, respectively). The aORs for all other outcomes were not statistically significant, except for blood transfusion (aOR 1.38, 95% CI 1.05-1.82) and venous thromboembolism (VTE) (aOR 7.93, 95% CI 2.97-21.22) in the group for HL during pregnancy. The proportion of anaemia was also increased in this group (69%, 95% CI 57%-80% vs 4%, 95% CI 4%-5%, respectively). The GRADE certainty of findings ranged from low to very low. CONCLUSIONS Rates of most adverse pregnancy outcomes among women with a previous/current HL diagnosis are not increased significantly compared with the general pregnant population. Women with HL diagnosed during pregnancy may have a higher PTB rate and increased likelihood of VTE, anaemia and blood transfusion; however, small study numbers and the low to very low GRADE certainty of findings preclude firm conclusions.
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Affiliation(s)
- Orla A Houlihan
- School of Public Health, University College Cork, Cork, Ireland
| | - Daire Buckley
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Gillian M Maher
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
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Cancer in pregnancy: treatment effects. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1774-1783. [PMID: 36639533 DOI: 10.1007/s00261-022-03787-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Pregnant patients present a unique challenge to cancer therapy. Due to the potential catastrophic implications related to teratogenic effects or pregnancy loss, oncologic management of this vulnerable patient group must be strategic and personalized. METHODS This article will discuss the unique treatment approach to the pregnant cancer patient. This includes discussion of the role of imaging during staging, treatment, and follow-up with an emphasis on avoiding ionizing radiation when possible. RESULTS AND CONCLUSION Specific considerations and modifications to standard cancer treatments, including surgery and systemic therapies such as chemotherapy, immunotherapy, targeted and hormone therapies are crucial components of providing oncologic care to minimize negative effects to the mother and developing fetus. Radiation and proton therapy are also options that may be employed in specific circumstances. Finally, this article will address the long-term treatment effects of these therapies on future fertility.
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Wang B, Jia Y, Liu L. The efficacy and safety of platinum-based chemotherapy for ovarian cancer in pregnancy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31954. [PMID: 36451508 PMCID: PMC9704992 DOI: 10.1097/md.0000000000031954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Ovarian cancer during pregnancy is a rare event. Little is known about the treatment of this condition due to lack of high level evidence. Therefore, we performed a protocol for systematic review and meta-analysis to evaluate the efficacy and safety of platinum-based chemotherapy for the treatment of ovarian cancer during pregnancy. METHODS This systematic review has been registered in PROSPERO (CRD42022370709), which will be conducted in accordance with preferred reporting items for systematic review and meta-analysis protocols 2015 statement. We will search 7 electronic databases to identify relevant studies from inception to October, 2022, which includes PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. The Cochrane Handbook for systematic reviews of interventions will be performed to assess a broad category of biases in the included studies. The Grading of Recommendations Assessment, Development and Evaluation system will be used to judge the overall quality of evidence supporting outcomes in this work. Data are analyzed with the Review Manager Version 5.3 software. RESULTS The results of this meta-analysis would be submitted to peer-reviewed journals for publication. CONCLUSION This paper will provide high-quality synthesis to assess the efficacy and safety of platinum-based chemotherapy for ovarian cancer in pregnancy.
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Affiliation(s)
- Bei Wang
- Department of Gynaecology, Hebei General Hospital, Shijiazhang, China
- * Correspondence: Bei Wang, Department of Gynaecology, Hebei General Hospital, Shijiazhang, Hebei 050051, China (e-mail: )
| | - Yiyi Jia
- Department of Gynaecology, Hebei General Hospital, Shijiazhang, China
| | - Liping Liu
- Graduate School, North China University of Science and Technology, Hebei, China
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12
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Karbhari N, Thomas AA. Clinical management of brain tumors in pregnancy. Curr Opin Oncol 2022; 34:691-697. [PMID: 36170169 DOI: 10.1097/cco.0000000000000894] [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 We review the diagnostic tools, treatment options, and clinical management for brain tumors diagnosed in pregnancy with consideration for management approaches that are best suited to preserve maternal and fetal health. RECENT FINDINGS Women of child-bearing age are at risk of developing brain tumors and are at increased risk compared with male counterparts for tumors that are hormonally driven. Brain tumors are rare neoplasms, and diagnosis of brain tumors in pregnancy is uncommon, such that management guidelines and treatment recommendations are lacking for most tumor types. We discuss the standard treatment options for brain tumors and the relative risks and safety when these treatments are considered during pregnancy. We review the neoplasms most commonly affecting pregnant women and the existing literature and guidelines. SUMMARY Pregnancy is a unique phase of life in which hormonal, immunologic, and vascular changes may impact tumor growth and presentation. Treatment decisions should consider the symptoms and stability of the pregnant patients, the gestational age and health of the fetus, and the location and behavior of the neoplasm.
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Affiliation(s)
- Nishika Karbhari
- Department of Neurology, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - Alissa A Thomas
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
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13
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Barreau L, Gau S, Loussert L, Vaysse C, Weyl A, Groussolles M. [Cancer during pregnancy: Proposal of a clinical care pathway based on a regional cohort]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:657-665. [PMID: 35843588 DOI: 10.1016/j.gofs.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Cancer during pregnancy affects 1 in 1000 pregnancies. This situation requires multidisciplinary team, however there is no care pathway dedicated to these patients. The main objective was to describe oncological, obstetrical, and neonatal care through a regional inventory. Our secondary objective was to define a regional "cancer and pregnancy" care pathway. MATERIAL AND METHOD We carried out an observational, retrospective study from 2013 to 2019 including 48 women (all cancer types) from 2013 to 2019 in Occitania. Then, we defined an "optimal care pathway" and we assessed whether it was respected in the breast cancer subgroup of our cohort. RESULTS Live births occurred in 79% of the women included. Maternal treatment was initiated during pregnancy for 67% of our population (44% chemotherapy). The most frequent pregnancy complication was preterm delivery (39%), mainly iatrogenic (86.6%). No patient in the group of breast cancer benefited from all of the ten criteria of the "optimal care pathway" that we proposed. CONCLUSIONS A coordinated regional care pathway seems necessary to optimize communication between the healthcare providers (oncologists, gynecologists and multidisciplinary prenatal diagnosis centers, pharmacologists, pediatricians, psychologists, and general practitioners). This study identifies weaknesses in the management of women with cancer during pregnancy and suggests regional improvement opportunities.
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Affiliation(s)
- L Barreau
- Maternité Paule-de-Viguier, CHU Toulouse Purpan, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
| | - S Gau
- Institut du cancer de Montpellier Val d'Aurelle, Parc Euromédecine EU, 208, avenue des Apothicaires, 34090 Montpellier, France.
| | - L Loussert
- Maternité Paule-de-Viguier, CHU Toulouse Purpan, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
| | - C Vaysse
- CHU Toulouse, Institut universitaire du cancer de Toulouse, Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
| | - A Weyl
- CHU Toulouse, Institut universitaire du cancer de Toulouse, Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
| | - M Groussolles
- Maternité Paule-de-Viguier, CHU Toulouse Purpan, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
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14
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Thain S, McMicking J, de Naurois J, Nelson-Piercy C. Challenges in management of gastrointestinal cancers in pregnancies: A report of three cases. Obstet Med 2022; 15:141-145. [DOI: 10.1177/1753495x20987047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 11/15/2022] Open
Abstract
Gastrointestinal cancer occurs in approximately 1 in 13,000 pregnancies, making up 4% of malignancies detected in pregnancy. It is a complex and challenging condition to diagnose and manage and is often only detected in its more advanced stages. This is partly due to symptoms of gastrointestinal cancer being incorrectly attributed to physiological symptoms of pregnancy, as well as concerns about the safety of diagnostic investigations in pregnancy, both of which may delay diagnosis and lead to disease progression. Challenges in management also arise from under-treatment in pregnancy due to concerns about the impact of surgery or chemotherapy on the pregnancy. We present here three cases of gastrointestinal cancer diagnosed in pregnancy in our centre and discuss the challenges and pitfalls one may encounter in the diagnosis and management of gastrointestinal malignancies in pregnancy.
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Affiliation(s)
- Serene Thain
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Jess McMicking
- Department of Obstetrics and Gynaecology, Guy’s and St Thomas’ Hospital, London, UK
| | - Julien de Naurois
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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15
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Systematic review of fetal and placental metastases among pregnant patients with cancer. Cancer Treat Rev 2022; 104:102356. [DOI: 10.1016/j.ctrv.2022.102356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
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16
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Iyer NS, Trager L, Gaughan J, Akoto S, Cardonick E. Paediatric dental outcomes among children exposed to chemotherapy in utero. Int J Paediatr Dent 2022; 32:116-122. [PMID: 33960557 DOI: 10.1111/ipd.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
AIM Our study prospectively evaluated dental development in children exposed to chemotherapy in utero compared with unexposed controls. DESIGN Women who received chemotherapy while pregnant were enrolled in a research registry. After age two, each child's dentist was asked to complete a questionnaire about dental abnormalities and malformations, as well as for their unexposed siblings. Multivariate linear regression adjusting for age was used to compare the groups. RESULTS Dental information was received for 67 exposed children and 59 controls. The majority of mothers were treated for breast cancer (79.1%) and primarily received doxorubicin (89.6%) and cyclophosphamide (80.6%). Mean gestational age at first exposure was 20.7 (±5.7) weeks. Mean age at dental evaluation was 8.0 (±4.3) years for exposed and 10.4 (±5.1) years for controls (P < .01). Missing teeth, tooth size, shape, and color did not differ significantly between groups. There was no statistical difference in dental caries, facial abnormalities, or abnormalities of enamel or gingiva. There was no association between any chemotherapy agent or regimen and increased risk of dental abnormalities. CONCLUSIONS Overall, there was no difference in dental abnormalities between groups. These negative findings may be because no one received chemotherapy prior to 14 weeks when formation of primary teeth was beginning.
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Affiliation(s)
- Neel S Iyer
- Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
| | - Lauren Trager
- Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, Boston, MA, USA
| | - John Gaughan
- Cooper Research Institute, Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Serwaa Akoto
- Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
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17
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Nowik CM, Gerrie AS, Wong J. Conservative Management of Presumed Fetal Anemia Secondary to Maternal Chemotherapy for Acute Myeloid Leukemia. AJP Rep 2021; 11:e137-e141. [PMID: 34925954 PMCID: PMC8674095 DOI: 10.1055/s-0041-1740561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/08/2021] [Indexed: 12/02/2022] Open
Abstract
Acute myeloid leukemia occurs rarely during pregnancy. When it is diagnosed remote from term, treatment in the form of daunorubicin plus cytarabine induction with consolidative cytarabine is typically undertaken after the first trimester. There is little data to guide fetal monitoring, in particular, whether and how often middle cerebral artery peak systolic velocity (MCA PSV) should be measured to screen for fetal anemia. Cytarabine may be particularly myelosuppressive to the fetus, but information pertaining to the management of this complication is also lacking in published literature. To our knowledge, we present the first case of presumed severe fetal anemia related to in utero exposure to chemotherapy that was managed conservatively with close sonographic monitoring, including serial measurement of MCA PSV. This case suggests that in the absence of hydrops fetalis or other signs of fetal decompensation, expectant management with ultrasound twice weekly, including MCA PSV, is appropriate. Ultrasounds may be decreased to weekly when MCA PSV does not suggest fetal anemia. Screening for fetal anemia can provide helpful information to guide the timing of chemotherapy administration and delivery. Key Points Chemotherapy for acute myeloid leukemia can cause fetal anemia.Fetal MCA PSV can be used to safely and effectively screen for fetal anemia.Observation of fetal anemia due to chemotherapy is reasonable, in the absence of hydrops.Monitoring of fetal MCA PSV can help guide timing of chemotherapy and delivery.
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Affiliation(s)
- Christina M. Nowik
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S. Gerrie
- Division of Hematology and Medical Oncology, University of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jonathan Wong
- Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Garutti M, Lambertini M, Puglisi F. Checkpoint inhibitors, fertility, pregnancy, and sexual life: a systematic review. ESMO Open 2021; 6:100276. [PMID: 34597942 PMCID: PMC8487000 DOI: 10.1016/j.esmoop.2021.100276] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/09/2021] [Indexed: 01/12/2023] Open
Abstract
Immune checkpoint inhibitors (i.e. anti-PD1, anti-PDL1, and anti-CTLA4) have revolutionized the therapeutic approach of several cancer types. In a subset of metastatic patients, the duration of the response is so long that a cure might be hypothesized, and a treatment discontinuation strategy could be proposed. Considering that long-term efficacy, some patients could also plan to have a child. Moreover, immunotherapy is moving to the early setting in several diseases including melanoma and breast cancer that are common cancers in young patients. However, there is a paucity of data about their potential detrimental effect on fertility, pregnancy, or sexuality. Herein, we conducted a systematic review with the aim to comprehensively collect the available evidence about fertility, pregnancy, and sexual adverse effects of checkpoint inhibitors in order to help clinicians in daily practice and trialists to develop future studies.
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Affiliation(s)
- M Garutti
- CRO Aviano National Cancer Institute IRCCS, Aviano, Italy.
| | - M Lambertini
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - F Puglisi
- CRO Aviano National Cancer Institute IRCCS, Aviano, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Department of Medicine (DAME), University of Udine, Udine, Italy
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19
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Kalampokas E, Vlahos N, Kalampokas T, Gurumurthy M. Common Malignancies During Pregnancy: A Comprehensive Review. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:103-109. [PMID: 35399318 DOI: 10.21873/cdp.10015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/05/2021] [Indexed: 01/31/2023]
Abstract
Malignant disease complicates pregnancy in up to 1 per 1,000-2,000 cases. Pregnancy itself does not constitute a predisposing factor for malignancy. Management and treatment of patients suffering from a malignancy during pregnancy still represents a challenge in everyday clinical practice. Recent advances in imaging, diagnostic and overall treatment modalities have tailored the management of patients, specifically those who wish to maintain the pregnancy. The aim of this review was to provide clinicians with concise information on the management of the most common malignancies during pregnancy. We performed a review of the current literature including review articles, original research articles and guidelines, which are used for the management of the most common malignancies during pregnancy. Breast, cervical and ovarian malignant tumours are the most common during pregnancy. However, the overall outcome and survival per stage for these cancers do not appear to be influenced by pregnancy. Ethical, emotional and treatment dilemmas may be encountered during treatment planning. Individualization of treatment planning should be made by a multidisciplinary team but the final decision rests with the parents.
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Affiliation(s)
| | - Nikolaos Vlahos
- Department of Obstetrics and Gynaecology, Aretaieio Hospital, Athens, Greece
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20
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Silverstein J, Post AL, Chien AJ, Olin R, Tsai KK, Ngo Z, Van Loon K. Multidisciplinary Management of Cancer During Pregnancy. JCO Oncol Pract 2021; 16:545-557. [PMID: 32910882 DOI: 10.1200/op.20.00077] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cancer during pregnancy is relatively rare but is increasing in frequency in countries in which the maternal child-bearing age continues to rise. The complexities of medical decision making are underscored by the need to weigh the potential benefits of any intervention for the mother against the risks to the fetus. A majority of diagnostic evaluations can be performed safely in the setting of pregnancy and should not be delayed. Noninvasive prenatal testing that shows discordance with fetal karyotype can be a clue to an underlying maternal malignancy. After diagnosis, a multidisciplinary team should formulate a care plan for both the mother and the fetus. Key topics for discussion should include the mother's prognosis, standard treatment plan, and predictions of how modifications for a continuing pregnancy will affect the treatment plan and overall prognosis. In the context of this knowledge, frank discussions about pregnancy termination should be addressed with the patient, if appropriate. Selection of a plan for oncologic management in the case of a pregnant woman is based on the type of cancer, the tumor biology, and the tumor stage. Additional complexities for pregnant patients are typically related to the gestational age of the fetus, the dynamic physiologic changes of pregnancy, and the limited safety data for administration of most anticancer therapies during pregnancy. In this article, we summarize data related to different classes of anticancer therapies as well as considerations for the management of selected cancers. Finally, we provide some key principles that should be considered in the management of patients with cancer during pregnancy.
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Affiliation(s)
- Jordyn Silverstein
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Annalisa L Post
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - A Jo Chien
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.,Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Rebecca Olin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.,Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Katy K Tsai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.,Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Zoe Ngo
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.,Department of Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.,Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
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21
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Willekens B, Kleffner I. Susac syndrome and pregnancy: a review of published cases and considerations for patient management. Ther Adv Neurol Disord 2021; 14:1756286420981352. [PMID: 33796140 PMCID: PMC7970706 DOI: 10.1177/1756286420981352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/24/2020] [Indexed: 12/31/2022] Open
Abstract
Susac syndrome (SuS) is a rare autoimmune endotheliopathy leading to hearing loss, branch retinal artery occlusions and encephalopathy. Young females are more frequently affected than males, making counselling for family planning an important issue. We reviewed published cases on SuS during pregnancy or in the postpartum period, and selected 27 reports describing the details of 33 patients with SuS. Treatment options and implications for pregnancy and breastfeeding are discussed. We propose new areas for research and suggest a management strategy.
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Affiliation(s)
- Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem, 2650, Belgium
| | - Ilka Kleffner
- University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
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22
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Alpuim Costa D, Nobre JG, de Almeida SB, Ferreira MH, Gonçalves I, Braga S, Pais D. Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?-A Scoping Review With Paradigmatic Cases-Based Analysis. Front Oncol 2020; 10:598508. [PMID: 33425755 PMCID: PMC7787159 DOI: 10.3389/fonc.2020.598508] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/17/2020] [Indexed: 12/29/2022] Open
Abstract
Ethical issues that arise during the care of a pregnant woman with cancer are challenging to physicians, policymakers, lawyers, and the bioethics community. The main purpose of this scoping review is to summarize existing literature regarding the bioethical dilemmas when a conflict arises in the maternal-fetus dyad, like the one related to cancer and pregnancy outcomes. Moreover, we illustrate the decision-making process of real-life case reports. Published data were searched through the PubMed and Google Scholar databases, as well as in grey literature, using appropriate controlled keywords in English and Portuguese. After identification, screening, eligibility and data extraction from the articles, a total of 50 was selected. There are several established ethical frameworks for conflict resolution and decision-making. Pragmatic theoretical approaches include case-based analysis, the ethics of care, feminist theory, and traditional ethical principlism that scrutinizes the framework of autonomy, justice, beneficence, and non-maleficence. In addition, society and practitioner values could mediate this complex ethical interplay. The physician must balance autonomy and beneficence-based obligations to the pregnant woman with cancer, along with beneficence-based obligations to the fetus. Ethical challenges have received less attention in the literature, particularly before the third trimester of pregnancy. Best, unbiased and balanced information must be granted both to the patient and to the family, regarding the benefits and harms for the woman herself as well as for the fetal outcome. Based on a previously validated method for analyzing and working up clinical ethical problems, we suggest an adaptation of an algorithm for biomedical decision-making in cancer during pregnancy, including recommendations that can facilitate counseling and help reduce the suffering of the patient and her family.
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Affiliation(s)
- Diogo Alpuim Costa
- CUF Oncologia, Haematology and Oncology Department, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | | | | | | | - Inês Gonçalves
- Hospital CUF Almada, Emergency Department, Almada, Portugal
| | - Sofia Braga
- CUF Oncologia, Haematology and Oncology Department, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal.,Hospital Professor Doutor Fernando Fonseca EPE, Oncology Department, Amadora, Portugal
| | - Diogo Pais
- Ethics Department, NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
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23
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Zagouri F, Dedes N, Papatheodoridi A, Liontos M, Dimopoulos MA. Supportive medication in cancer during pregnancy. BMC Pregnancy Childbirth 2020; 20:747. [PMID: 33261562 PMCID: PMC7706269 DOI: 10.1186/s12884-020-03432-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023] Open
Abstract
While pregnancy-related malignancies are quite rare, their incidence is increasing and thus affecting more and more women nowadays. Their management, however, with both chemotherapy and supportive agents remains quite challenging and it seems crucial to define the optimal treatment for this special population. Concerning supportive medication, it is clinically significant to determine whether commonly used agents, including Granulocyte Colony-Stimulating Factors, Erythropoiesis-stimulating agents, Bisphosphonates, Anticoagulation agents, Antiemetics and Glucocorticoids are indeed effective in ameliorating chemotherapy side effects. Meanwhile, it is of great importance that the administration of any of these agents is safe for both mother and fetus. This review aims to provide a précis of the current literature regarding both safety and efficacy of all categories of supportive medication during pregnancy.
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Affiliation(s)
- Flora Zagouri
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece.
| | - Nikolaos Dedes
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece
| | - Alkistis Papatheodoridi
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece
| | - Michael Liontos
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece
| | - Meletios Athanasios Dimopoulos
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece
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24
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Leung V, Bryant C, Stafford L. Psychological aspects of gestational cancer: A systematic review. Psychooncology 2020; 29:1734-1745. [PMID: 32779263 DOI: 10.1002/pon.5502] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Gestational cancer is defined as any type of cancer diagnosed during pregnancy or within 12 months of delivery. To date, existing studies on the psychological aspects of this type of cancer have not been evaluated for methodological quality. The aim of this systematic review was to identify the psychological aspects of gestational cancer. METHODS Five journal databases were searched to identify peer-reviewed articles reporting upon the psychological aspects of women with gestational cancer. Studies published from journal inception to December 2019 were included, and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The Mixed-Method Appraisal Bias Tool was used, to assess the methodological quality of the studies. A narrative description was developed for the psychological outcomes reported in quantitative studies. Qualitative data was synthesized using thematic analysis. RESULTS Five papers were eligible for inclusion (two qualitative and three quantitative studies). Factors that contributed to women's psychological distress during gestational cancer included disease characteristics, sociodemographic factors, the baby's health, pregnancy-related factors and cognitive emotion regulation. Four main themes emerged from the qualitative studies; concerns about the baby's health, lost opportunities, "not fitting in," and healthcare decision-making. CONCLUSIONS These findings suggest that (a) women with gestational cancer experience psychological distress that is associated with concerns about their babies' health, and (b) their healthcare experiences are affected by communication within multidisciplinary care teams.
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Affiliation(s)
- Vivien Leung
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Lesley Stafford
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Women's Mental Health, The Royal Women's Hospital, Parkville, Victoria, Australia
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25
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Marbun VMG, Putranto AS. Diagnosis and management of gastric cancer in pregnancy-An evidence-based case report. Int J Surg Case Rep 2020; 75:338-344. [PMID: 32980705 PMCID: PMC7522585 DOI: 10.1016/j.ijscr.2020.09.109] [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: 09/02/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gastric cancer in pregnancy is a very rare case with an incidence of 0.016% and is mostly detected in a locally advanced or advanced stage due to misinterpretation of non-specific signs and symptoms. Management of gastric cancer in pregnancy should emphasize mother and fetal survival. Currently, there is no diagnostic and management guidance for gastric cancer in pregnancy. The purpose of this study is to ascertain how to diagnose and manage gastric cancer in pregnancy. METHODS This study is an evidence-based case report performed in Digestive Division of Department of Surgery in Cipto Mangunkusumo hospital in September-October 2017. Literature search on databases such as Cochrane, PubMed, ScienceDirect, and Scholar Google used keywords like "gastric cancer" AND "pregnant" OR "pregnancy" with inclusion criteria which are systematic review, randomized-clinical trial (RCT), cohort study, case report, or case series, performed in human and published in the last 10 years in English language. Critical appraisal is done according to Oxford Centre For Evidence-Based Medicine 2011. This work is reported in line with the SCARE criteria. RESULTS There are 9 case-report studies and 1 case-control study. Radiology examination includes endoscopy, MRI, and CT scan. Management is given according to cancer stage which is; surgery, surgery with adjuvant therapy, and palliative chemotherapy. CONCLUSION Radiology examinations with a lower risk of adverse effects are endoscopy and MRI. CT scan may be performed when the benefits exceed the risk. Surgery and chemoradiation have the lowest rate of adverse effects when done in the second and third trimester.
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Affiliation(s)
- Vania Myralda Giamour Marbun
- Digestive Division of General Surgery Department, Faculty of Medicine, Universitas Indonesia, General Surgery Department, Cipto Mangunkusumo Hospital, Jalan Diponegoro #71, Senen, Central Jakarta, Indonesia.
| | - Agi Satria Putranto
- Digestive Division of General Surgery Department, Faculty of Medicine, Universitas Indonesia, General Surgery Department, Cipto Mangunkusumo Hospital, Jalan Diponegoro #71, Senen, Central Jakarta, Indonesia.
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26
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Figueroa-Espada CG, Hofbauer S, Mitchell MJ, Riley RS. Exploiting the placenta for nanoparticle-mediated drug delivery during pregnancy. Adv Drug Deliv Rev 2020; 160:244-261. [PMID: 32956719 DOI: 10.1016/j.addr.2020.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
A major challenge to treating diseases during pregnancy is that small molecule therapeutics are transported through the placenta and incur toxicities to the developing fetus. The placenta is responsible for providing nutrients, removing waste, and protecting the fetus from toxic substances. Thus, the placenta acts as a biological barrier between the mother and fetus that can be exploited for drug delivery. Nanoparticle technologies provide the opportunity for safe drug delivery during pregnancy by controlling how therapeutics interact with the placenta. In this Review, we present nanoparticle drug delivery technologies specifically designed to exploit the placenta as a biological barrier to treat maternal, placental, or fetal diseases exclusively, while minimizing off-target toxicities. Further, we discuss opportunities, challenges, and future directions for implementing drug delivery technologies during pregnancy.
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27
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Revoredo F, de Vinatea J, Reaño G, Villanueva L, Kometter F, Arenas J, Polanco PM. Mucinous cystic neoplasms of the pancreas associated with pregnancy: Two case reports. Medicine (Baltimore) 2020; 99:e21471. [PMID: 32756169 PMCID: PMC7402798 DOI: 10.1097/md.0000000000021471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Although rare, pancreatic neoplasms can occur during pregnancy, both in benign and malignant forms. Mucinous cystic neoplasms (MCNs) of the pancreas, a type of these neoplasms, are precursor lesions to invasive pancreatic cancer. The presence of the ovarian-type stroma is a defining feature. PATIENT CONCERNS The first case was a 38-year-old woman in her 18th week of pregnancy with abdominal pain that worsens a few weeks later. The second case was a 30-year-old woman in her 17th week of pregnancy with abdominal pain in the left hypochondrium. DIAGNOSIS The patients were under clinical examination and laboratory test including carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). Both patients had magnetic resonance imaging (MRI). The diagnosis of a MCNs of the pancreas was done preoperatively in the 2 cases. INTERVENTIONS Both patients underwent distal pancreatectomy during pregnancy. One of them was an emergency laparotomy because of a ruptured MCN. OUTCOMES Both patients were completely recovered from distal pancreatectomy and continued to full term, delivering a healthy baby by Caesarean section. After 6 years of follow-up, the first patient underwent a total gastrectomy, because of a gastric cancer with carcinomatosis. Currently the 2 patients are still alive after 8 years and 5 years of follow-up, respectively. LESSONS Surgical resection of MCNs during pregnancy should be considered during the second trimester given common distal pancreas location, rapid growth, risk of spontaneous rupture, and malignant potential.
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Affiliation(s)
| | | | | | | | | | - José Arenas
- Department of Pathology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
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28
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Castellanos MI, Childress KJ, Ramirez M, Venkatramani R. Fetal exposure to capecitabine and temozolomide during the first trimester: A case report. J Gynecol Obstet Hum Reprod 2020; 49:101881. [PMID: 32712180 DOI: 10.1016/j.jogoh.2020.101881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022]
Abstract
Literature on the outcome of pregnancy after exposure to capecitabine and temozolomide during the first trimester is scarce. Chemotherapy administration in the first trimester is generally not recommended due the potential risks to the fetus including fetal death and major congenital malformations. Capecitabine and temozolomide are oral chemotherapy agents and pregnancy category D medications, thus the use of these agents in pregnancy is not recommended. We present the case of a 17-year-old female who while receiving cancer treatment, had unintentional exposure to capecitabine and temozolomide during the first trimester of pregnancy, and subsequently delivered a healthy infant.
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Affiliation(s)
- Maria I Castellanos
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States.
| | - Krista J Childress
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, 30322, United States.
| | - Mildred Ramirez
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, United States.
| | - Rajkumar Venkatramani
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States.
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29
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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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30
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Abstract
Cancer complicates 1 in 1000 pregnancies. Multidisciplinary consensus comprised of Gynecologic Oncology, Pathology, Neonatology, Radiology, Anesthesiology, Maternal Fetal Medicine, and Social Work should be convened. Pregnancy provides an opportunity for cervical cancer screening, with deliberate delays in treatment permissible for early stage carcinoma. Vaginal delivery is contraindicated in the presence of gross lesion(s) and radical hysterectomy with lymphadenectomy at cesarean delivery is recommended. Women with locally advanced and metastatic/recurrent disease should commence treatment at diagnosis with chemoradiation and systemic therapy, respectively; neoadjuvant chemotherapy to permit gestational advancement may be considered in select cases. Most adnexal masses are benign and resolve by the second trimester. Persistent, asymptomatic, benign-appearing masses can be managed conservatively; surgery, if indicated, is best deferred to 15-20 weeks, with laparoscopy preferable over laparotomy whenever possible. Benign and malignant germ cell tumors and borderline tumors are occasionally encountered, with unilateral adnexectomy and preservation of the uterus and contralateral ovary being the rule. Epithelial ovarian cancer is exceedingly rare. Ultrasonography and magnetic resonance imaging lack ionizing radiation and can be employed to evaluate disease extent. Tumor markers, including CA-125, AFP, LDH, inhibin-B, and even CEA and ßhCG may be informative. If required, chemotherapy can be administered following organogenesis during the second and third trimesters. Because platinum and other anti-neoplastic agents cross the placenta, chemotherapy should be withheld after 34 weeks to avoid neonatal myelosuppression. Bevacizumab, immune checkpoint inhibitors, and PARP inhibitors should be avoided throughout pregnancy. Although antenatal glucocorticoids to facilitate fetal pulmonary maturation and amniotic fluid index assessment can be considered, there is no demonstrable benefit of tocolytics, antepartum fetal heart rate monitoring, and/or amniocentesis. Endometrial, vulvar, and vaginal cancer in pregnancy are curiosities, although leiomyosarcoma and the dreaded twin fetus/hydatidiform mole have been reported. For gynecologic malignancies, pregnancy does not impart aggressive clinical behavior and/or worse prognosis.
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Affiliation(s)
- Travis-Riley K Korenaga
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA.
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31
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Laws HJ, Baumann U, Bogdan C, Burchard G, Christopeit M, Hecht J, Heininger U, Hilgendorf I, Kern W, Kling K, Kobbe G, Külper W, Lehrnbecher T, Meisel R, Simon A, Ullmann A, de Wit M, Zepp F. Impfen bei Immundefizienz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:588-644. [PMID: 32350583 PMCID: PMC7223132 DOI: 10.1007/s00103-020-03123-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hans-Jürgen Laws
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität FAU Erlangen-Nürnberg, Erlangen, Deutschland
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
| | - Gerd Burchard
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland
| | - Maximilian Christopeit
- Interdisziplinäre Klinik für Stammzelltransplantation, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Jane Hecht
- Abteilung für Infektionsepidemiologie, Fachgebiet Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Berlin, Deutschland
| | - Ulrich Heininger
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Universitäts-Kinderspital beider Basel, Basel, Schweiz
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Kern
- Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Kerstin Kling
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland.
| | - Guido Kobbe
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Wiebe Külper
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lehrnbecher
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Roland Meisel
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Andrew Ullmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maike de Wit
- Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Onkologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - Fred Zepp
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Deutschland
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32
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Alfasi A, Ben-Aharon I. Breast Cancer during Pregnancy-Current Paradigms, Paths to Explore. Cancers (Basel) 2019; 11:cancers11111669. [PMID: 31661803 PMCID: PMC6896197 DOI: 10.3390/cancers11111669] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is the most common form of malignancy in pregnant women. The prevalence of pregnancy-associated breast cancer (PABC) is up to 0.04% of pregnancies and is expected to rise in developed countries. PABC represents a unique clinical scenario which requires a delicate balance of risks and benefits for both maternal and fetal well-being. Currently, there is paucity of data regarding the short- and long-term outcomes of in-utero exposure to anti-neoplastic agents. In general, when possible, treatment for PABC should follow the same guidelines as in non-pregnant patients. Surgery, including sentinel lymph node biopsy, is possible during all trimesters of pregnancy. Radiotherapy is contraindicated during pregnancy, although it might be considered in highly selected patients based on risk-benefit assessment. Evidence supports that administration of chemotherapy may be safe during the second and third trimesters, with cessation of treatment three weeks prior to expected delivery. Currently, hormonal therapy and anti-HER2 agents are contraindicated during pregnancy and should be postponed until after delivery. Prematurity is associated with worse neonatal and long-term outcomes, and thus should be avoided. While current data on the long-term effects of anti-neoplastic treatments are reassuring, grade of evidence is lacking, hence additional large prospective studies with long-term follow-up are essential to rule out any treatment-induced adverse effects.
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Affiliation(s)
- Ayelet Alfasi
- Division of Oncology, Rambam Health Care Center, Haifa 3109601, Israel.
| | - Irit Ben-Aharon
- Division of Oncology, Rambam Health Care Center, Haifa 3109601, Israel.
- Rapport Faculty of Medicine, Technion, Haifa 3200000, Israel.
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33
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Yp Z, J D, Xw Z, J L, Y S. Maternal and neonatal outcomes of cancer during pregnancy: a multi-center observational study. J Cancer 2019; 10:5727-5734. [PMID: 31737109 PMCID: PMC6843891 DOI: 10.7150/jca.33746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/12/2019] [Indexed: 12/21/2022] Open
Abstract
Cancer during pregnancy has increased because of the increased maternal age at the time of the first pregnancy and/or second child policy in China. The main purpose of the study is to report the existing data concerning the maternal and children's outcomes in pregnant women complicating cancer. In this multi-center, prospective cohort study, we compared women diagnosed with cancer during pregnancy and their children with matched women without cancer diagnoses. The primary outcomes were maternal and children's mortalities, as well as the Ages and Stages Questionnaires-3(ASQ) of children. A total of 80,524 pregnant women were screened. Of whom 83(0.1%) were diagnosed with cancer during pregnancy. Death occurs in 42.2% (35/83) women during follow-up. During pregnancy, 24 women terminated pregnancy before 28 weeks and among this 8(33.3%) died. Ten women received chemotherapy and 49 did not receive chemotherapy. Compared with the matched controls, there were less incidences of premature rupture of membrane (5.1% vs 35.6%, P=0.000) and more caesarean rates (84.7% vs 52.5%, P=0.001) and with higher pregnancy order (2.7±1.7 vs 2.0±1.0, P=0.007) in pregnant women with cancer. These women also had increased mortality compared with control group (45.8% vs 1.7%, P=0.000). Women who received chemotherapy had a statistically significant lower mortality rate when compared to the non-chemotherapy group (1:9 vs 26:23, P=0.016). However, there were no differences found in mortality of children and ASQ assessment between two groups. Chemotherapy may result in reduced mortality of women diagnosed with cancer during pregnancy, without affecting the mortality of children and ASQ-associated development.
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Affiliation(s)
- Zhang Yp
- Department of Pediatrics, The Second Affiliated Hospital of the Third Military Medical University, Chongqing, 400037 China
| | - Duan J
- Department of Pediatrics, the People's Hospital of Shapingba District, Chongqing, 400030, China
| | - Zhu Xw
- Department of Neonatology, Jiulongpo People's Hospital, Chongqing, 400024, China
| | - Li J
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Shi Y
- China International Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China
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Kasenda S, Mategula D, Chiphangwi N, Gadama LA, Masamba LPL. High-Risk Adult Wilms' Tumour in Pregnancy: A Case Report. Malawi Med J 2019; 31:155-158. [PMID: 31452850 PMCID: PMC6698624 DOI: 10.4314/mmj.v31i2.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Wilms' tumour is the most common renal neoplasm in children with an incidence of 10 cases per 1 million children and a median age at diagnosis of 3.5 years. In Western countries its occurrence in adults is 0.2 cases per million people in western countries and carries a poorer prognosis. The co-existence of Adult Wilms' tumour and pregnancy is extremely rare with less than 20 cases published in the English literature. We present a case of a Malawian woman who had progressive high-risk metastatic Adult Wilms' tumour in pregnancy after nephrectomy, radiotherapy and two lines of chemotherapy.
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Affiliation(s)
| | - Donnie Mategula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Noel Chiphangwi
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Luis Aaron Gadama
- Department of Obstetrics and Gynaecology Department, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
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35
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Eastwood-Wilshere N, Turner J, Oliveira N, Morton A. Cancer in Pregnancy. Asia Pac J Clin Oncol 2019; 15:296-308. [PMID: 31436920 DOI: 10.1111/ajco.13235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/22/2019] [Indexed: 12/25/2022]
Abstract
Cancer in pregnancy may be increasing in incidence with advancing maternal age and higher rates of obesity. The diagnosis of cancer in pregnancy provokes complex management issues balancing short- and long-term risks for both mother and baby. Every case needs to be individualized, with a multidisciplinary team of midwives, obstetricians, oncologists, surgeons, radiation oncologists, and neonatologists assisting the family to make informed decisions regarding the best treatment course for the mother and baby. The present article reviews the evidence regarding the safety of diagnostic imaging, procedures and treatment modalities for cancer for the pregnant woman and fetus. The efficacy of novel anticancer therapies highlight the need for International Registries to accumulate safety data for these agents in pregnancy as expeditiously as possible.
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Affiliation(s)
- Naomi Eastwood-Wilshere
- Department of Obstetric Medicine, Mater Health Brisbane, South Brisbane, Queensland, Australia
| | - Jessica Turner
- Department of Medical Oncology, Mater Health Brisbane, South Brisbane, Queensland, Australia
| | - Niara Oliveira
- Department of Obstetrics and Gynaecology, Mater Health Brisbane, South Brisbane, Queensland, Australia
| | - Adam Morton
- Department of Obstetric Medicine, Mater Health Brisbane, South Brisbane, Queensland, Australia
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36
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Gastric cancer during pregnancy with placental involvement: case report and review of published works. Obstet Gynecol Sci 2019; 62:357-361. [PMID: 31538080 PMCID: PMC6737060 DOI: 10.5468/ogs.2019.62.5.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/26/2018] [Accepted: 01/22/2019] [Indexed: 01/22/2023] Open
Abstract
Gastric cancer involving the placenta during pregnancy is rare; however, we present 1 such case in this report. A 31-year-old Japanese woman was referred at 26 weeks of gestation for the evaluation of a swollen left supraclavicular lymph node. Biopsy revealed poorly differentiated adenocarcinoma, and esophagogastroduodenoscopy with biopsy of the stomach confirmed the diagnosis of gastric cancer. Her epigastric and back pain became more pronounced and her general status worsened, and we performed a cesarean delivery at 29 weeks. Microscopic examination of the placental specimen revealed poorly differentiated adenocarcinoma cells diffused into the intervillous space. Postpartum chemotherapy consisted of S-1 plus oxaliplatin. Unfortunately, this treatment was ineffective, and the patient died 3 months after delivery. The infant did well, without clinical or laboratory manifestations of metastasis. In patients with advanced gastric cancer during pregnancy, it is important to perform a microscopic examination of the placenta to evaluate for metastatic involvement.
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37
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Depoix CL, Colson A, Mhallem-Gziri M, Hubinont C, Debieve F. Effects of chemotherapy on placental development and function using in vitro culture of human primary cytotrophoblasts. Invest New Drugs 2019; 38:547-557. [PMID: 31155684 DOI: 10.1007/s10637-019-00800-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/22/2019] [Indexed: 02/01/2023]
Abstract
Introduction Cancers during pregnancy can be treated with chemotherapy after the first trimester but the treatment is associated with smaller placentas and an increased risk of stillbirth, fetal growth retardation and preterm delivery. We decided to assess the effect of several chemotherapeutic agents on placental development by using in vitro culture of human term cytotrophoblasts. Methods Cytotrophoblasts isolated from term placentas were cultured for 48 h and treated for 24 h with epirubicin, docetaxel, vinblastine, methotrexate, tamoxifen, 4-hydroxytamoxifen, and endoxifen. First, cell viability was assessed. Then, the effect of the treatment on trophoblast differentiation and placental angiogenesis was assessed by quantifying hCG and PlGF mRNA and protein expression. Finally, the expression of two efflux transporters, BCRP and MDR1 was investigated. Results Epirubicin only strongly decreased cell viability. Epirubicin, docetaxel, and vinblastine inhibited HCGB and PlGF expression while methotrexate, tamoxifen and its two metabolites increased it. BCRP was essentially expressed in syncytiotrophoblasts and MDR1 in undifferentiated cytotrophoblasts. Their expression was not affected by the drugs but vinblastine increased BCRP mRNA expression by 2.8-fold. Discussion The most commonly used chemotherapeutic drugs are well supported in vitro by syncytiotrophoblasts, except for epirubicin, which was very cytotoxic. Chemotherapy perturbed the expression of genes normally upregulated during placental differentiation and angiogenesis but not the expression of the drug transporters. Further studies looking at the effect of combination therapy and the transporter capacities to reject the drugs will be needed to better define the effects of chemotherapy on placental development and function.
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Affiliation(s)
- Christophe Louis Depoix
- Department of Obstetrics, Institut de Recherche Clinique et Expérimentale (IREC), Université Catholique de Louvain, Avenue Mounier 52, 5th floor, Woluwe-Saint-Lambert, 1200, Bruxelles, Belgium.
| | - Arthur Colson
- Department of Obstetrics, Institut de Recherche Clinique et Expérimentale (IREC), Université Catholique de Louvain, Avenue Mounier 52, 5th floor, Woluwe-Saint-Lambert, 1200, Bruxelles, Belgium
| | - Mina Mhallem-Gziri
- Department of Obstetrics, Institut de Recherche Clinique et Expérimentale (IREC), Université Catholique de Louvain, Avenue Mounier 52, 5th floor, Woluwe-Saint-Lambert, 1200, Bruxelles, Belgium
| | - Corinne Hubinont
- Department of Obstetrics, Institut de Recherche Clinique et Expérimentale (IREC), Université Catholique de Louvain, Avenue Mounier 52, 5th floor, Woluwe-Saint-Lambert, 1200, Bruxelles, Belgium
| | - Frederic Debieve
- Department of Obstetrics, Institut de Recherche Clinique et Expérimentale (IREC), Université Catholique de Louvain, Avenue Mounier 52, 5th floor, Woluwe-Saint-Lambert, 1200, Bruxelles, Belgium
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38
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Newton HL, Friend AJ, Feltbower R, Hayden CJ, Picton HM, Glaser AW. Survival from cancer in young people: An overview of late effects focusing on reproductive health. Acta Obstet Gynecol Scand 2019; 98:573-582. [DOI: 10.1111/aogs.13584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/06/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Hannah L. Newton
- Reproduction and Early Development Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine School of Medicine and Health, University of Leeds Leeds UK
- Leeds Institute of Health Research School of Medicine and Health University of Leeds Leeds UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Amanda J. Friend
- Leeds Institute of Health Research School of Medicine and Health University of Leeds Leeds UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Richard Feltbower
- Department of Clinical and Population Sciences, School of Medicine and Health University of Leeds Leeds UK
- Leeds Institute for Data Analytics University of Leeds Leeds UK
| | | | - Helen M. Picton
- Reproduction and Early Development Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine School of Medicine and Health, University of Leeds Leeds UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Adam W. Glaser
- Leeds Institute of Health Research School of Medicine and Health University of Leeds Leeds UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
- Leeds Institute for Data Analytics University of Leeds Leeds UK
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Incidence of Neonatal Neutropenia and Leukopenia After In Utero Exposure to Chemotherapy for Maternal Cancer. Am J Clin Oncol 2019; 42:351-354. [DOI: 10.1097/coc.0000000000000527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sato K, Shimamoto H, Mochizuki Y, Hirai H, Tomioka H, Shimizu R, Marukawa E, Fukayama H, Yoshimura R, Ishida H, Harada H. Treatment of oral cancers during pregnancy: a case-based discussion. J Otolaryngol Head Neck Surg 2019; 48:9. [PMID: 30717781 PMCID: PMC6360730 DOI: 10.1186/s40463-019-0331-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 01/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Malignancies occur in approximately 1:1000 pregnancies; the most common being breast (46%) and hematological (18%) malignancies. Oral cancers account for only 2% of all cancers in pregnant women, and there are no standard guidelines for the treatment of oral cancer during pregnancy. Methods Between 2007 and 2014, our department managed 1109 patients with oral cancers; four (0.4%) had tongue carcinomas during pregnancy. These cases were retrospectively reviewed. Results The four women were aged 29–39 (median 32.5) years. Two underwent partial glossectomy at 39 and 40 weeks’ gestation, respectively, one received radiotherapy at 17 weeks’ gestation, and one underwent supraomohyoid neck dissection and hemi-glossectomy with a forearm flap reconstruction. Conclusion In addition to tumor factors, the wishes of the patient and her family, gestational age, and fetal and maternal conditions are important factors in deciding on a treatment protocol. Moreover, treatment decisions require multidisciplinary approach.
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Affiliation(s)
- Kiyoshi Sato
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hideaki Hirai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Risa Shimizu
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Eriko Marukawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Haruhisa Fukayama
- Department of Anesthesiology and Clinical Physiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroo Ishida
- Department of Medical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Jahani M, Azadbakht M, Rasouli H, Yarani R, Rezazadeh D, Salari N, Mansouri K. L-arginine/5-fluorouracil combination treatment approaches cells selectively: Rescuing endothelial cells while killing MDA-MB-468 breast cancer cells. Food Chem Toxicol 2019; 123:399-411. [DOI: 10.1016/j.fct.2018.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022]
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Capriglione S, Manzano A, Gulino FA, Lopez S. Management of gynecological cancer in pregnant patients. ACTA ACUST UNITED AC 2018; 71:133-145. [PMID: 30318875 DOI: 10.23736/s0026-4784.18.04324-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cancer during pregnancy is a rare but challenging condition. More women delay childbearing and consequently the incidence of cancer during pregnancy is constantly increasing. EVIDENCE ACQUISITION An extensive electronic search was performed in PubMed and Scopus. Only studies written after 1985 were considered eligible for this review. Abstracts, conference papers, book chapters, animal studies, commentaries as well as editorials articles were excluded from this review. EVIDENCE SYNTHESIS Cancer treatment during pregnancy is possible, but both maternal and fetal conditions need to be preserved. Randomized clinical trials are not feasible and current evidence are mainly based on case-series, small case reports and expert opinion. Cervical and ovarian cancers are the most common gynecological cancers diagnosed during pregnancy. Surgery and chemotherapy after the first trimester seem to be relatively safe for the newborn. Platinum-based chemotherapy administered during the 2nd-3rd trimester showed comparable adverse effects in newborns to those in the general population. Babies exposed to antenatal chemotherapy might be more likely to develop small for gestational age and NICU admission, than babies not exposed. CONCLUSIONS Management of pregnant women with cancer should be performed in specialized cancer centers and all cases should be discussed with a multidisciplinary approach. In the present review, we discuss the current recommendations for the management of pregnancies complicated by cancer and neonatal outcomes.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynecology, Institute for Social Security, Borgo Maggiore, San Marino
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | | | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA - .,Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Chuang SC, Lin CH, Lu YS, Hsiung CA. Association of pregnancy and mortality in women diagnosed with breast cancer: A Nationwide Population Based Study in Taiwan. Int J Cancer 2018; 143:2416-2424. [PMID: 30070358 DOI: 10.1002/ijc.31777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/06/2018] [Accepted: 07/18/2018] [Indexed: 12/11/2022]
Abstract
We examined the associations between breast cancer diagnosed during pregnancy and up to 5 years postpartum and total mortality. Breast cancer patients were identified from the Taiwan Cancer Registry (2002-2014). All pregnancies up to 5 years before breast cancer diagnosis were abstracted from the National Health Insurance database and data were then linked to the Taiwan National Death Certificate Database. Follow-up was calculated from the date of breast cancer diagnosis to the date of death or 31 December, 2014, whichever came first. The hazard ratios (HRs) and the 95% confidence intervals (CI) of the association between pregnancy and total mortality were estimated using Cox proportional hazard models. Among the 30,230 breast cancer patients, 90 were diagnosed during pregnancy, 347 within a year postpartum, and 1993 during 1-5 years postpartum. By the end of 2014, 2,920 patients were dead. The major cause of death was breast cancer (89%). Compared to patients without pregnancy records, the HRs were 1.42 (95% CI = 0.83-2.45) for patients diagnosed during pregnancy, 1.29 (0.96-1.74) for those diagnosed within a year postpartum, 1.27 (0.95-1.70) for those diagnosed within 1 to 2 years postpartum, and 1.06 (0.88-1.27) for those diagnosed ≥2 to 5 years postpartum, after adjustment for tumor characteristics and treatment. Subgroup analyses revealed an increased risk of mortality for patients diagnosed within a year postpartum in ER+ cancers (HR = 2.11, 95% CI = 1.28-3.47). Our results suggested a recent pregnancy may be associated with higher mortality among ER+ patients.
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Affiliation(s)
- Shu-Chun Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Ching-Hung Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
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Amante MA, Galagnara SJP, Ignacio J. Anaplastic large cell lymphoma in a pregnant Filipino woman successfully treated with prepartum and postpartum chemotherapy. BMJ Case Rep 2018; 2018:bcr-2018-225576. [PMID: 30209141 DOI: 10.1136/bcr-2018-225576] [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: 11/04/2022] Open
Abstract
Diagnosis of a malignancy during pregnancy presents a dilemma regarding the work-up and treatment of the patient. This report presents a 42-year-old woman on her 23rd week of pregnancy with multiple enlarging fungating violaceous skin masses. Biopsy of the dominant mass revealed anaplastic large cell lymphoma. Due to the progressive enlargement and increase in number of the masses, the patient was given two cycles of chemotherapy (doxorubicin, vincristine, cyclophosphamide and prednisone) before delivering a live baby boy via spontaneous vaginal delivery, Apgar 9.9, at 37 4/7 weeks. After delivery, she completed four more cycles of treatment. A full-body positron emission tomography scan done 2 months after the last chemotherapy showed no evidence of disease. The patient is doing well with no evidence of disease 9 months after treatment. Her baby is thriving and has no gross deformities and no developmental delays.
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Affiliation(s)
- Madelaine Amurao Amante
- Section of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Sharon Jane Pingol Galagnara
- Section of Perinatology, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jorge Ignacio
- Section of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Carcinoma of gastro-oesophageal junction in a pregnant woman. GASTROENTEROLOGY REVIEW 2018; 13:163-165. [PMID: 30002778 PMCID: PMC6040096 DOI: 10.5114/pg.2018.75822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/19/2018] [Indexed: 12/04/2022]
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Iavazzo C, Minis EE, Gkegkes ID. Current management of gynecologic cancer in pregnancy. J Turk Ger Gynecol Assoc 2018; 19:104-110. [PMID: 29699959 PMCID: PMC5994818 DOI: 10.4274/jtgga.2018.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer during pregnancy is a particularly challenging complication. The incidence has increased in recent years due to childbearing at advanced maternal ages due to career choices and/or the development of reproductive technology. Approximately two thirds of cancer cases during pregnancy comprise invasive cervical cancers and breast cancer. Cancer during gestation is characterized by a need for specialized treatment due to major changes in the hormonal profile (estrogen-progesterone), metabolism (enhancement of anabolism), hemodynamic changes (hyperdynamic circulation), immunologic changes (cell-mediated and humoral immunity), and increased angiogenesis (increased blood flow towards the uterus). Moreover, the management of such patients is based on the trimester of pregnancy, type and stage of cancer, and informed consent of the mother based on her wishes. The optimal treatment of cancer during pregnancy remains elusive because there are limited data from retrospective studies with small samples. As a result, it is crucial that data regarding survival of the women and long-term follow-up of the children from different cancer centers and registries are shared. This need is dictated by the fact that the incidence of cancer during pregnancy will continue to rise as child-bearing age continues to increase.
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Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Ioannis D Gkegkes
- Department of Surgery, General Hospital of Attica “KAT”, Athens, Greece
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Chen Y, Luo Y, Han C, Tian W, Yang W, Wang Y, Xue F. Ovarian dysgerminoma in pregnancy: A case report and literature review. Cancer Biol Ther 2018; 19:649-658. [PMID: 29580145 DOI: 10.1080/15384047.2018.1450118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Dysgerminoma is an uncommon malignant tumor arising from the germ cells of the ovary. Its association with pregnancy is extremely rare; the incidence is about 0.2-1 per 100,000 pregnancies. Because of its infrequency, there are few recommendations regarding its management in pregnancy; therefore, it is important to discuss and summarize the treatment strategy. CASE We presented a case of a 23-year-old pregnant woman with a large dysgerminoma originated from the right ovary, which had the unusual coincidence of being associated with an abdominal desmoid tumor simultaneously. We did not find any similar cases published in the PubMed database after 1947. A cesarean section was performed at 34 + 6 weeks gestation secondary to her abdominal pain worsening. The patient delivered a healthy boy and had fertility-preserving surgery, followed by 6 cycles of chemotherapy. This case is compared with 21 other reported cases of pure ovarian dysgerminoma in the literature to evaluate the clinical characteristics, feto-maternal compromise, treatment, long-term survival, and fertility outcome. CONCLUSION The treatment strategy in women with ovarian dysgerminoma should be discussed and structured on an individual basis. If pregnancy is desired, surgical intervention undertaken in the second trimester seems to be the first choice. When chemotherapy is indicated, unless delivery can be accomplished within a few weeks of diagnosis, it should not necessarily be delayed until after delivery. Good reproductive function and high survival rate can be achieved in patients treated with conservative surgery and adjuvant chemotherapy.
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Affiliation(s)
- Yuanyuan Chen
- a Obstetrics and Gynecology Department , Tianjin Medical University General Hospital , No.154, Anshan Road, Heping District , Tianjin , China
| | - Ying Luo
- a Obstetrics and Gynecology Department , Tianjin Medical University General Hospital , No.154, Anshan Road, Heping District , Tianjin , China
| | - Cha Han
- a Obstetrics and Gynecology Department , Tianjin Medical University General Hospital , No.154, Anshan Road, Heping District , Tianjin , China
| | - Wenyan Tian
- a Obstetrics and Gynecology Department , Tianjin Medical University General Hospital , No.154, Anshan Road, Heping District , Tianjin , China
| | - Wen Yang
- a Obstetrics and Gynecology Department , Tianjin Medical University General Hospital , No.154, Anshan Road, Heping District , Tianjin , China
| | - Yingmei Wang
- a Obstetrics and Gynecology Department , Tianjin Medical University General Hospital , No.154, Anshan Road, Heping District , Tianjin , China
| | - Fengxia Xue
- a Obstetrics and Gynecology Department , Tianjin Medical University General Hospital , No.154, Anshan Road, Heping District , Tianjin , China
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Jagels B, Amin L, Gustafson A. Pregnancy and Cancer Treatment: Developing a Standardized Testing Policy and Procedure. Clin J Oncol Nurs 2018; 22:218-219. [PMID: 29547613 DOI: 10.1188/18.cjon.218-219] [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: 11/17/2022]
Abstract
Systematic gaps for pregnancy screening and testing of patients with cancer persist. Absent or inconsistent guidelines and policies are barriers to standardized practice. Awareness among oncology nurses is needed to promote safe cancer care, prevent patient harm, and uphold patient-centered care.
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Lee SF, Burge M, Eastgate M. Metastatic colorectal cancer during pregnancy: A tertiary center experience and review of the literature. Obstet Med 2018; 12:38-41. [PMID: 30891091 DOI: 10.1177/1753495x18755958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/03/2018] [Indexed: 01/13/2023] Open
Abstract
Background Colorectal cancer during pregnancy is rare. Diagnosis may be delayed and clinicians are faced with unique challenges when formulating management plans, having to consider the well-being of both fetus and mother. Cases Our series outlines five cases of metastatic colorectal cancer during pregnancy. There was one patient who presented in each of the first, second and third trimesters, whilst the remaining were post-partum. Diagnosis was difficult as the patients were either asymptomatic or their symptoms were misconstrued as features of pregnancy. Two patients received chemotherapy while pregnant but only one had a successful delivery. Survival of patients in this series ranged between 1 and 35 months from diagnosis. Conclusion Women with gestational colorectal cancer are often diagnosed at an advanced stage and have a poor prognosis.
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Affiliation(s)
- Shu Fen Lee
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Matthew Burge
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Melissa Eastgate
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia
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Abstract
PURPOSE OF REVIEW Cancer in pregnancy has become increasingly frequent. It has become clear that for specific cancers under well defined circumstances, oncological treatment in pregnancy can be well tolerated and feasible for both mother and fetus. Continued critical assessment of the available literature and registration of cancer in pregnancy cases and outcomes for mother and child are necessary to work toward implementing optimal cancer treatment during pregnancy. RECENT FINDINGS Physiologic changes in pregnancy may alter distribution and efficacy of systemic therapy. Data on systemic therapy including, chemotherapy, hormonal therapy, and targeted therapy during pregnancy are available but incomplete. Outcomes of fetuses exposed to chemotherapy in utero are generally reassuring, but new targeted therapies are mostly discouraged in pregnancy. SUMMARY Cancer treatment during pregnancy is possible, depending on type and timing of systemic therapy and treatment modality. Available data are reassuring with a modest increase in complications such as growth restriction and preterm birth. The effect of new targeted therapies is often still unclear and therefore discouraged.
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