Chemo Safe for Fetus During Later Pregnancy
MADRID ― In utero exposure to chemotherapy appears to be safe, for the most part, when administered after the first trimester, according to data presented here at the European Society for Medical Oncology Congress 2014.
"Fear about the risks of chemotherapy administration should not be a reason to terminate a pregnancy, delay cancer treatment for the mother (which can jeopardize outcomes), or deliver a baby prematurely," said lead researcher Frederic Amant, MD, from University Hospitals Leuven in Belgium.安徽省立医院肿瘤科何义富
A caseCcontrol study on the developmental outcome of children exposed to chemotherapy in utero showed that chemotherapy does not adversely affect mental development or cardiac functioning.
The mental development of children almost 2 years of age did not differ significantly between those exposed to chemotherapy and control subjects. Cardiac dimensions and functions were also within the normal range for both groups.
However, chemotherapy is contraindicated during the first trimester of pregnancy, cautioned Hatem A. Azim Jr., MD, from the Jules Bordet Institute in Brussels, during a discussion of the study. "We can usually wait until the second trimester," he said.
Dr. Azim noted that "abortion should not be considered except in cases of aggressive disease diagnosed very early in the pregnancy," and that "premature delivery should be avoided unless complications require early induction of labor."
A conference attendee asked about the safety of anthracyclines, which are a widely used and effective treatment for a large spectrum of childhood cancers. Their use is limited by associated progressive and clinically significant cardiotoxic effects, which can be acute, early, or late. Dr. Azim noted that anthracyclines appear to be safe during pregnancy, "but at the end of the day, we must treat the mother and her desire to keep the pregnancy."
There are not a lot of data, but the adverse events appear to be minimal in children who are several years old now, compared with those not exposed to these drugs. "I don't think there are enough data for me to stop offering anthracyclines in pregnancy at this time," he said.
Dr. Amant added that the key to therapy is individualization. "By definition, all types of chemotherapy are not safe," he said.
Previous Evidence
In Europe, approximately 2500 to 5000 pregnant women are diagnosed with cancer every year; however, it remains unclear how systemic chemotherapy affects the development of the fetus. Thus, oncologists have been hesitant to administer chemotherapy to pregnant cancer patients.
A small study, which Dr. Amant presented at the 2011 European Multidisciplinary Cancer Congress, showed that children exposed to chemotherapy in utero did not appear to suffer any detrimental effects in terms of general health or neurologic or cardiac functioning.
Two review articles published in 2012 supported these findings, and led to the conclusion that pregnancy should be preserved whenever possible with breast and gynecologic cancers. These are the 2 most common malignancies diagnosed during pregnancy, and pregnancy does not have a deleterious effect on the prognosis of either. It is possible to provide standard therapy to the mother while safeguarding the fetus, the review authors noted.