[Reproductive and developmental toxicity studies of paclitaxel. (III)--Intravenous administration to rats during the perinatal and lactation periods]

Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy

BACKGROUND

Ovarian cancer diagnosed during pregnancy is uncommon. Paclitaxel-based chemotherapy during pregnancy has not been reported previously.

CASE

A woman with ascites and an adnexal mass diagnosed during pregnancy at 27 weeks gestational age underwent a laparotomy with cytoreductive surgery and was diagnosed with stage IIIC papillary serous ovarian adenocarcinoma. She was treated with three cycles of paclitaxel and cisplatin during pregnancy. At 37 weeks, she underwent a cesarean section, abdominal hysterectomy, and cytoreduction. Three additional cycles of chemotherapy were given. She developed a recurrence within 6 weeks of completing chemotherapy. She received several cycles of chemotherapy, but died of recurrent cancer 29 months after diagnosis. The infant has normal growth and development at 30 months of age.

CONCLUSION

This is the first reported case of paclitaxel use during pregnancy.

Chemotherapy in pregnancy

There is limited information concerning the effects of chemotherapy administered during pregnancy, which consists mostly of case reports and small series. The National Cancer Institute maintains a registry of neonates exposed to chemotherapy but there are currently only several hundred cases. When chemotherapy is used during embryogenesis, there is an increased rate of spontaneous abortions and major birth defects. The risk of fetal malformations when chemotherapy is administered during the second and third trimesters is probably not greater than the background rate. Use in the second and third trimesters may increase the risk of premature birth, fetal growth restriction, maternal and fetal myelosuppression, and still births.