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Velazquez C, Loier L, Struys I, Verscheure E, Persoons L, Godderis L, Lenaerts L, Amant F. Additive genotoxic effects in cord blood cells upon indirect exposure to chemotherapeutic compounds crossing an in vitro placental barrier. Sci Rep 2024; 14:19598. [PMID: 39179576 PMCID: PMC11344073 DOI: 10.1038/s41598-024-62250-5] [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: 11/29/2023] [Accepted: 05/15/2024] [Indexed: 08/26/2024] Open
Abstract
Prenatal exposure to toxins can adversely affect long-term health outcomes of the offspring. Though chemotherapeutics are now standard of care for treating cancer patients during pregnancy, certain compounds are known to cross the placenta and harm placental tissue. The consequences for the fetus are largely unexplored. Here we examined the responses of newborn cord blood mononuclear cells in tissue culture to two chemotherapeutic drugs, cyclophosphamide and epirubicin, when either directly exposed to these drugs, or indirectly after crossing a placenta trophoblast bilayer barrier. Cord blood mononuclear cells exposed to the conditioned media obtained from cyclophosphamide-exposed trophoblast barriers showed a significant 2.4-fold increase of nuclear ROS levels compared to direct exposure to cyclophosphamide. Indirect exposure to epirubicine-exposed trophoblast barriers not only enhanced nuclear ROS levels but also significantly increased the fraction of cord blood cells with double strand breaks, relative to directly exposed cells. Neither apoptosis nor proliferation markers were affected in cord mononuclear blood cells upon direct or indirect exposure to cyclophosphamide or epirubicin. Our data suggests that trophoblast cells exposed to cyclophosphamide or epirubicine may induce an indirect 'bystander' effect and can aggravate genotoxicity in the fetal compartment.
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Affiliation(s)
- Carolina Velazquez
- Department of Oncology, Laboratory of Gynaecological Oncology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lien Loier
- Department of Oncology, Laboratory of Gynaecological Oncology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ilana Struys
- Department of Oncology, Laboratory of Gynaecological Oncology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eline Verscheure
- Center for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Leentje Persoons
- Department of Microbiology, Immunology and Transplantation, Laboratory of Virology and Chemotherapy, Rega Institute, KU Leuven, 3000, Leuven, Belgium
| | - Lode Godderis
- Center for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Idewe, External Service for Prevention and Protection at Work, Interleuvenlaan 58, 3001, Heverlee, Belgium
| | - Liesbeth Lenaerts
- Department of Oncology, Laboratory of Gynaecological Oncology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, Laboratory of Gynaecological Oncology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
- Department of Gynecology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Heimovaara JH, Huis In 't Veld EA, Lok CAR, Garcia AC, Halaska MJ, Boere I, Gziri MM, Fruscio R, Painter RC, Cardonick E, van den Heuvel-Eibrink MM, Masturzo B, Van Calsteren K, van Zuylen L, Amant F. Maternal death by cancer in pregnancy: A descriptive study of the International Network on Cancer, Infertility and Pregnancy. BJOG 2024. [PMID: 38923226 DOI: 10.1111/1471-0528.17894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To characterise pregnant women diagnosed with primary or recurrent cancer who died during pregnancy, during delivery or within 1 year postpartum. DESIGN A descriptive study. SETTING The registry of the International Network on Cancer, Infertility and Pregnancy (INCIP). POPULATION Women diagnosed with cancer during pregnancy between 2000 and 2022. METHODS Using the INCIP registry database, we compared the characteristics of all women with cancer who died during pregnancy, delivery or within 1 year postpartum with those of all women with cancer who survived the first year postpartum. MAIN OUTCOME MEASURES Maternal and tumour characteristics and obstetrical and neonatal outcomes. RESULTS Of the 2359 women registered in INCIP, there were 131 cases (5.6%) of maternal mortality. Lung cancer (9/14, 64.3% of all registered women with lung cancer), gastro-oesophageal cancer (13/21, 61.9%) and acute leukaemia (17/105, 16.2%) had the highest rates of maternal mortality. Maternal mortality was associated with fewer live births compared with the control group without maternal mortality (99/131, 75.6%, vs 1952/2163, 90.0%; P < 0.001), more elective caesarean sections (64/104, 60.4%, vs 756/1836, 41.2%; P < 0.001) and a lower gestational age at (induced) delivery (34.0 vs 37.1 weeks; P < 0.001), resulting in more preterm births. CONCLUSIONS Maternal mortality occurred in 5.6% of cancer-in-pregnancy cases and is associated with adverse perinatal outcomes.
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Affiliation(s)
- Joosje H Heimovaara
- Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Gynaecological Oncology, Centre of Gynaecological Oncology Amsterdam, Location Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Evangeline A Huis In 't Veld
- Department of Gynaecological Oncology, Centre of Gynaecological Oncology Amsterdam, Location Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Christianne A R Lok
- Department of Gynaecological Oncology, Centre of Gynaecological Oncology Amsterdam, Location Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alvaro Cabrera Garcia
- Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) 'Reference Clinic for Hemato-Oncological Diseases during Pregnancy CREHER' Estado de México, Ixtapaluca, Mexico
| | - Michael J Halaska
- University Hospital Kralovske Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Ingrid Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | - Robert Fruscio
- Clinic of Obstetrics and Gynaecology, University of Milan - Bicocca, Fondazione IRCCS San Gerardo, Monza, Italy
| | - Rebecca C Painter
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Elyce Cardonick
- Department of Obstetrics and Gynaecology, Cooper University Health Care, Camden, New Jersey, USA
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands
- University Medical Centre - Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - B Masturzo
- Department of Obstetrics and Gynaecology, University of Turin, Città Della Salute e Della Scienza, Sant'Anna Hospital, Turin, Italy
| | - Kristel Van Calsteren
- Division of Fetomaternal Medicine, Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium
- Department of Development and Regeneration, Unit of Woman and Child, KU Leuven, Leuven, Belgium
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centre, Cancer Centre Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Frederic Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Gynaecological Oncology, Centre of Gynaecological Oncology Amsterdam, Location Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium
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Van Assche IA, Van Calsteren K, Lemiere J, Hohmann J, Blommaert J, Huis In 't Veld EA, Cardonick E, LeJeune C, Ottevanger NPB, Witteveen EPO, van Grotel M, van den Heuvel-Eibrink MM, Lagae L, Lambrecht M, Amant F. Long-term neurocognitive, psychosocial, and physical outcomes after prenatal exposure to radiotherapy: a multicentre cohort study of the International Network on Cancer, Infertility, and Pregnancy. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:433-442. [PMID: 38640941 DOI: 10.1016/s2352-4642(24)00075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The main data available on the safety of radiation during pregnancy originate from animal studies and from studies of survivors of atomic or nuclear disasters. The effect of radiotherapy to treat maternal cancer on fetal development is uncertain. This report presents a unique cohort and aims to determine the long-term neurocognitive, psychosocial and physical outcomes of offspring of mothers treated with radiotherapy during pregnancy. METHODS In this international, multicentre, mixed retrospective-prospective cohort study, we recruited participants between Aug 5, 2006, and Aug 24, 2023, aged between 1·5 and 46 years, at three referral centres in Belgium, the Netherlands, and the USA. Participants were eligible if they were born from mothers treated with radiotherapy during pregnancy. Fetal radiation doses were obtained from medical records and participants were followed up at predefined ages (1·5, 3, 6, 9, 12, 15, and 18 years) and 5-yearly in adulthood, based on age at enrolment, using a neurocognitive test battery (measuring intelligence, attention, and memory), parent-reported executive function and psychosocial questionnaires, and a medical assessment. Results were compared with test-specific normative data. Linear regression models investigated associations between radiotherapy factors (fetal radiation dose, gestational age at the start and end of radiotherapy, and radiotherapy duration) and outcomes. FINDINGS 68 maternal cases of radiotherapy during pregnancy were registered by the three participating centres, of which 61 resulted in a livebirth and were therefore eligible to participate in the child follow-up study. After excluding those who did not give consent, 43 participants born from 42 mothers treated with radiotherapy during pregnancy were included in the study (median age at first assessment 3 years [IQR 2-11]; median age at last assessment 12 years [9-18]; median number of assessments two [1-4]). 18 (42%) of the included participants were female and 25 (58%) male, and 37 (86%) were of White ethnicity. Mean neurocognitive outcomes of the entire cohort were within normal ranges. No associations were found with fetal radiation dose or timing of radiotherapy during pregnancy. Six (16%) of 38 participants with neurocognitive outcomes scored lower than one SD on at least one neurocognitive outcome, three (7%) reported chronic medical conditions (spasmophilia, spastic diplegia, and IgG deficiency), and three (7%) were diagnosed with attention-deficit hyperactivity disorder (of whom two scored lower on attention). Of ten (23%) participants with lower neurocognitive score(s), a chronic medical condition, or attention-deficit hyperactivity disorder, eight were born preterm. The remaining 33 (77%) participants showed no neurocognitive, psychosocial, or chronic physical problems. INTERPRETATION We show on average normal neurocognitive, psychosocial, and physical outcomes after prenatal exposure to radiotherapy. Differences in outcomes could not be explained by exposure to radiotherapy during pregnancy. These results suggest that extra-abdomino-pelvic radiotherapy exposure during pregnancy in general does not adversely affect outcomes of liveborn children. Further research with a larger sample is necessary to confirm these findings. FUNDING Kom Op Tegen Kanker, KWF Kankerbestrijding, Stichting Tegen Kanker, Research Foundation Flanders.
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Affiliation(s)
- Indra A Van Assche
- Unit of Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kristel Van Calsteren
- Unit of Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Unit of Foetomaternal Medicine, Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Unit of Paediatric Oncology, Department of Oncology, KU Leuven, Leuven, Belgium; Unit of Paediatric Haemato-Oncology, Department of Paediatrics, UZ Leuven, Leuven, Belgium
| | - Jana Hohmann
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Jeroen Blommaert
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium; Unit of Gynaecological Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Evangeline A Huis In 't Veld
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Center for Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ, USA
| | - Charlotte LeJeune
- Unit of Foetomaternal Medicine, Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium; Unit of Gynaecological Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Nelleke P B Ottevanger
- Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Els P O Witteveen
- Department of Medical Oncology, University Medical Centre Utrecht, Netherlands
| | | | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Division of Child Health, University Medical Centre Utrecht-Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Lieven Lagae
- Unit of Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Unit of Paediatric Neurology, Department of Paediatrics, UZ Leuven, Leuven, Belgium
| | - Maarten Lambrecht
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiation Oncology, UZ Leuven, Leuven, Belgium
| | - Frédéric Amant
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium; Unit of Gynaecological Oncology, Department of Oncology, KU Leuven, Leuven, Belgium; Center for Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
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Greiber IK, Viuff JH, Karlsen MA, Lidegaard Ø, Mikkelsen AP, Hjortshøj CS, Storgaard L, Mellemkjær L. School performance and educational achievement in children exposed to maternal cancer in utero. J Epidemiol Community Health 2024; 78:395-401. [PMID: 38589221 DOI: 10.1136/jech-2023-221753] [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: 12/05/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND In utero exposure to maternal cancer and cancer treatment might influence the child's cognitive development. This study investigated if exposure to maternal cancer during fetal life impacted school performance and educational achievement as adults. METHODS This nationwide retrospective cohort study identified all live-born children in Denmark between January 1978 and December 2013. Exposure was defined as maternal cancer diagnosis during pregnancy. Four partly overlapping birth cohorts were constructed depending on the outcome of interest: (1) receiving special educational support for birth years 2001-2013; (2) grade point average (GPA) at the final exams after 10th grade for 1986-2003; (3) educational achievement at 20 years for 1978-1998; and (4) education at 30 years for 1978-1988. Logistic and linear models were adjusted for birth year, maternal age, maternal education and maternal death. RESULTS The estimated probability of receiving special educational support was similar in the exposed group and the reference (adjusted OR 0.96; 95% CI 0.46 to 1.77, non-significant). The GPA did not statistically differ (0.13 grade points; 95% CI -0.18 to 0.45, non-significant). The achieved educational levels were similar for the exposed group and the reference at 20 years, with an adjusted OR of 1.07 (95% CI 0.82 to 1.40) for low versus medium educational level, and at 30 years with an adjusted OR of 0.73 (95% CI 0.35 to 1.50) for low versus high educational level and of 1.07 (95% CI 0.66 to 1.72) for medium versus high educational level. CONCLUSION Our findings did not indicate poorer performance in compulsory school nor impairment of adult educational achievement after exposure to maternal cancer in utero.
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Affiliation(s)
- Iben Katinka Greiber
- Department of Gynecology and Obstetrics, Rigshospitalet, Juliane Marie Centre, Kobenhavn, Denmark
- Danish Cancer Society Research Center, Kobenhavn, Denmark
| | | | - Mona Aarenstrup Karlsen
- Department of Gynecology and Obstetrics, Rigshospitalet, Juliane Marie Centre, Kobenhavn, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology and Obstetrics, Rigshospitalet, Juliane Marie Centre, Kobenhavn, Denmark
| | | | | | - Lone Storgaard
- Department of Gynecology and Obstetrics, Rigshospitalet, Juliane Marie Centre, Kobenhavn, Denmark
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Huis in ’t Veld EA, Van Assche IA, Amant F. Long-term outcomes of children after prenatal exposure to maternal cancer and its treatment. Acta Obstet Gynecol Scand 2024; 103:757-760. [PMID: 38419133 PMCID: PMC10993341 DOI: 10.1111/aogs.14811] [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: 11/17/2023] [Revised: 01/12/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
The incidence of antenatal cancer is increasing, prompting a medical-ethical evaluation. The International Network on Cancer, Infertility, and Pregnancy (INCIP) was established to study cancer treatment safety during pregnancy and its impact on maternal and child health. Pivotal research has led to a paradigm shift in clinical management, demonstrating the feasibility and safety of most antenatal oncological treatments. Short-term outcomes reveal normal growth and cardiac function in the exposed offspring, but caution is advised against first-trimester chemotherapy. Psychological impact studies highlight the elevated levels of distress in pregnant cancer patients, underscoring the need for personalized information and ongoing psychological support. Long-term follow-up studies address gaps in postnatal impacts, while research into specific chemotherapeutic agents continues. Despite generally reassuring outcomes, continued monitoring is crucial, especially in families, such as those where the child was born premature after cancer (treatment) during pregnancy or where mothers are frequently absent due to continued illness or have died from. The ongoing INCIP child follow-up initiative aims to further elucidate knowledge gaps, emphasizing the importance of large-scale studies and personalized patient care.
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Affiliation(s)
- Evangeline A. Huis in ’t Veld
- Center for Gynecological OncologyNetherlands Cancer InstituteAmsterdamThe Netherlands
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Indra A. Van Assche
- Department of Development and RegenerationUnit of Woman and Child, KU LeuvenLeuvenBelgium
| | - Frederic Amant
- Center for Gynecological OncologyNetherlands Cancer InstituteAmsterdamThe Netherlands
- Department of OncologyUnit of Gynecological OncologyKU LeuvenBelgium
- Department of Obstetrics and Gynecology, Division of Gynecological OncologyUZ LeuvenLeuvenBelgium
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Struys I, Velázquez C, Devriendt K, Godderis L, Segers H, Thienpont B, van Boxtel R, Van Calsteren K, Voet T, Wolters V, Lenaerts L, Amant F. Evaluating offspring Genomic and Epigenomic alterations after prenatal exposure to Cancer treatment In Pregnancy (GE-CIP): a multicentric observational study. BMJ Open 2024; 14:e081833. [PMID: 38548357 PMCID: PMC10982724 DOI: 10.1136/bmjopen-2023-081833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Around 1 in 1000-2000 pregnancies are affected by a cancer diagnosis. Previous studies have shown that chemotherapy during pregnancy has reassuring cognitive and cardiac neonatal outcomes, and hence has been proposed as standard of care. However, although these children perform within normal ranges for their age, subtle differences have been identified. Given that chemotherapeutic compounds can cross the placenta, the possibility that prenatal chemotherapy exposure mutates the offspring's genome and/or epigenome, with potential deleterious effects later in life, urges to be investigated. METHODS AND ANALYSES This multicentric observational study aims to collect cord blood, meconium and neonatal buccal cells at birth, as well as peripheral blood, buccal cells and urine from infants when 6, 18 and/or 36 months of age. Using bulk and single-cell approaches, we will compare samples from chemotherapy-treated pregnant patients with cancer, pregnant patients with cancer not treated with chemotherapy and healthy pregnant women. Potential chemotherapy-related newborn genomic and/or epigenomic alterations, such as single nucleotide variants, copy number variants and DNA-methylation alterations, will be identified in mononuclear and epithelial cells, isolated from blood, buccal swabs and urine. DNA from maternal peripheral blood and paternal buccal cells will be used to determine de novo somatic mutations in the neonatal blood and epithelial cells. Additionally, the accumulated exposure of the fetus, and biological effective dose of alkylating agents, will be assessed in meconium and cord blood via mass spectrometry approaches. ETHICS AND DISSEMINATION The Ethics Committee Research of UZ/KU Leuven (EC Research) and the Medical Ethical Review Committee of University Medical Center Amsterdam have approved the study. Results of this study will be disseminated via presentations at (inter)national conferences, through peer-reviewed, open-access publications, via social media platforms aimed to inform patients and healthcare workers, and through the website of the International Network on Cancer, Infertility and Pregnancy (www.cancerinpregnancy.org).
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Affiliation(s)
- Ilana Struys
- Department of Oncology, KU Leuven, Leuven, Flanders, Belgium
| | | | - Koenraad Devriendt
- Department of Human Genetics, University Hospital Leuven, Leuven, Belgium
| | - Lode Godderis
- Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
- External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Heidi Segers
- Department of Paediatric Oncology, University Hospital Leuven, Leuven, Belgium
| | | | - Ruben van Boxtel
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - Thierry Voet
- Department of Human Genetics, KU Leuven, Leuven, Flanders, Belgium
- Institute for Single Cell Omics (LISCO), KU Leuven, Leuven, Flanders, Belgium
| | - Vera Wolters
- Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Frederic Amant
- Department of Oncology, KU Leuven, Leuven, Flanders, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
- Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
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Favero D, Lapuchesky LS, Poggio F, Nardin S, Perachino M, Arecco L, Scavone G, Ottonello S, Latocca MM, Borea R, Puglisi S, Cosso M, Fozza A, Spinaci S, Lambertini M. Choosing the appropriate pharmacotherapy for breast cancer during pregnancy: what needs to be considered? Expert Opin Pharmacother 2023; 24:1975-1984. [PMID: 38179613 DOI: 10.1080/14656566.2023.2293167] [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: 09/03/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed malignancy during pregnancy. Breast cancer during pregnancy is a challenging clinical condition requiring proper and timely multidisciplinary management. AREAS COVERED This review focuses on the management of breast cancer during pregnancy with a focus about the current state-of-the-art on the feasibility and safety of pharmacotherapy approaches in this setting. EXPERT OPINION Multidisciplinary care is key for a proper diagnostic-therapeutic management of breast cancer during pregnancy. Engaging patients and their caregivers in the decision-making process is essential and psychological support should be provided. The treatment of patients with breast cancer during pregnancy should follow the same recommendations as those for breast cancer in young women outside pregnancy but taking into account the gestational age at the time of treatment.Anthracycline-, cyclophosphamide-, and taxane-based regimens can be safely administered during the second and third trimesters with standard protocols, preferring weekly regimens whenever possible. Endocrine therapy, immune checkpoint inhibitors, and targeted agents are contraindicated throughout pregnancy, also due to the very limited data available to guide their administration in this setting. During treatment, careful fetal growth monitoring is mandatory, and even after delivery proper health monitoring for the children exposed in utero to chemotherapy should be continued.
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Affiliation(s)
- Diletta Favero
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Sabina Lapuchesky
- Department of Medical Oncology, Instituto Alexander Fleming, University of Buenos Aires, Buenos Aires, Argentina
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Nardin
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Perachino
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Graziana Scavone
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Ottonello
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Maddalena Latocca
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Borea
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Puglisi
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Cosso
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Fozza
- Department of Radiotherapy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Spinaci
- Division of Breast Surgery, Ospedale Villa Scassi, Genoa, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Sorouri K, Loren AW, Amant F, Partridge AH. Patient-Centered Care in the Management of Cancer During Pregnancy. Am Soc Clin Oncol Educ Book 2023; 43:e100037. [PMID: 37220323 DOI: 10.1200/edbk_100037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The management of cancer during pregnancy requires a patient-centered, multidisciplinary approach to balance maternal and fetal well-being given the rarity of this clinical scenario and lack of substantial data. Involvement of oncology and nononcology medical specialists and ethical, legal, and psychosocial supports, as needed, is instrumental in navigating the complexities of care for this patient population. Critical periods of fetal development and physiological changes in pregnancy must be considered when planning diagnostic and therapeutic approaches during pregnancy. The complexity of symptom recognition and interventional approaches contributes to diagnostic delays of cancers during pregnancy. Ultrasound and whole-body diffusion-weighted magnetic resonance imaging are safe throughout pregnancy. Surgery can be safely performed throughout pregnancy, with the early second trimester preferred for intra-abdominal surgery. Chemotherapy can be safely administered after 12-14 weeks of gestation until 1-3 weeks before the anticipated delivery. Most targeted and immunotherapeutic agents are contraindicated during pregnancy because of limited data. Pelvic radiation during pregnancy is absolutely contraindicated, while if radiation to the upper body is needed, administration should only be considered early in pregnancy. To ensure that the total cumulative fetal exposure to ionizing radiation does not exceed 100 mGy, early inclusion of the radiology team in the care plan is required. Closer prenatal monitoring is recommended for maternal and fetal treatment-related toxicities. Delivery before 37 weeks of gestation should be avoided if possible, and vaginal delivery is preferred unless obstetrically indicated or specific clinical scenarios. Postpartum, breastfeeding should be discussed, and the neonate should receive blood work to assess for acute toxicities with follow-up arranged for long-term monitoring.
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Affiliation(s)
- Kimia Sorouri
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alison W Loren
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Frédéric Amant
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- KU Leuven, Leuven, Belgium
- University of Amsterdam, Amsterdam, the Netherlands
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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