Chemotherapy During Pregnancy

chemotherapyThe Lancet Oncology and The Lancet recently carried information on the safety of treating  most cancers in pregnant women with chemotherapy. The reports note that prematurity carries a higher risk than chemotherapy for the infant.

Frederic Amant, PhD, of University Hospitals Leuven in Leuven, Belgium, and colleagues reported online in The Lancet Oncology that children exposed to chemotherapy in utero showed no delay in growth or increase in problems with their central nervous system, heart, or hearing compared with the general population,

“True oncological emergencies in pregnant patients are rare (except for leukemia),” Philippe Morice, MD, of Institut Gustave Roussy in Villejuif, France, and colleagues wrote in a commentary accompanying the Lancet series. That makes timing the big question in cancer treatment during pregnancy, they noted.

The commentary stated, “The crux of the dilemma is finding a balance between the need to delay treatment while the fetus develops and the need to induce a premature delivery.”

Prematurity was the one risk identified among 70 children exposed to chemotherapy as part of their mothers’ treatment for cancer during pregnancy in a multicenter observational study by Amant’s group.

Two-thirds of the children were born before 37 weeks gestation. Their cognitive development scores, although still in the normal range, were lower than those carried to term.

Each additional month of gestation was associated with a statistically significant 11.6-point mean increase in IQ (100 is average).

Other assessments, including behavior, overall health, hearing, and growth, came up normal for the children exposed in utero to chemotherapy who were followed to about age 2.

Some subtle differences in cardiac and neuro-cognitive measures, though, might warrant further monitoring, Amant’s group suggested.

Elyce Cardonick, MD, of Cooper University Hospital in Camden, N.J., wrote in an accompanying commentary, “This study can reassure pregnant women, and their physicians, that the benefits of maternal treatment do not seem to be outweighed by any long-term consequences for the exposed fetus with regards to cardiac or neurological function.”

For the mothers, available evidence also suggests that these women don’t face higher mortality risk from their cancers than non-pregnant cancer patients, Dr. Morice noted.

With regard to a review specific to treating Breast cancer in pregnant women, Dr. Amant suggested that there is no reason to terminate the pregnancy, since it doesn’t improve prognosis for the mother. Treatment is not only possible during pregnancy but can actually improve the outlook for the baby by preventing medically-induced preterm birth, Amant’s group reported.

Chemotherapy is supported by evidence for use after fetal organs form, which is from 14 weeks’ gestation on, while surgery can be done during any trimester.

Radiation, depending on the dose received by the fetus, can result in poor fetal outcomes, so that decision should be made on an individual basis, the researchers noted.The diagnostic strategy should also be discussed with multidisciplinary help to reduce fetal radiation exposure, they  added.

While Chemotherapy has been proven to be an acceptable treatment, targeted and hormonal therapies like bevacizumab (Avastin) and trastuzumab (Herceptin) were noted as contraindicated in pregnancy for women with breast cancer.

Primary source: The Lancet
Source reference:
Morice P, et al “Gynaecological cancers in pregnancy” Lancet 2012; 379: 558–69.

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