Obstetric risks of chemotherapy during pregnancy

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Abstract

During the first 4 weeks of gestation, the embryo is not yet differentiated and exposure to chemotherapy occurs the all-or-nothing principle. Most vulnerable to chemotherapy is the period from 5 to 10 weeks of pregnancy, the use of 1 cytostatic increases the risk of malformations in the hearth up to 10%, and a few - up to 25%. Prescription of therapy after 12 weeks is not associated with the risk of malformations. Development, but leads to delayed growth of the fetus and pancytopenia in newborns in 30%. Probability of a metostatic lesion the placenta and fetus is extremely low and is described primarily for hematogenous tumors. The course of treatment must be completed in 3 weeks. Before giving birth.

About the authors

Yu E Dobrokhotova

N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

д-р мед. наук, проф., зав. каф. акушерства и гинекологии лечебного фак-та 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1

E I Borovkova

N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: katyanikitina@mail.ru
д-р мед. наук, проф. каф. акушерства и гинекологии лечебного фак-та 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1

References

  1. Hatem A, Azim Jr. Managing cancer during pregnancy. Springer, 2016; p. 191.
  2. Ring A.E, Smith I.E, Ellis P.A. Breast cancer and pregnancy. Ann Oncol 2005; 16 (12): 18555-60.
  3. Beadle B.M, Woodward W.A, Middleton L.P, Tereffe W. The impact of pregnancy on breast cancer outcomes in women before 35 years. Cancer 2009; 115 (6): 1174-84.
  4. Amant F, Deckers S, Van Calsteren K, Loibl S. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer 2010; 46 (18): 3158-68.
  5. Mir O, Berveiller P. Increased evidence for use of chemotherapy in pregnancy. Lancet Oncol 2012; 13 (9): 852-4.
  6. Loibl S, Han S.N, von Minckwitz G et al. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 2012; 13 (9): 887-96.
  7. Amant F, Halaska M.J, Fumagalli M, Dahl Steffensen K. Gynecologic cancers in pregnancy: guideline of a Second International Consensus Meeting. Int J Gynecol Cancer 2014; 24 (3): 394-03.
  8. Mir O, Berveiller P, Pons G. Trastuzumsb - mechanism of action and use. N Engl J Med 2007: 357 (16): 1664-5.
  9. Loibl S, Sdhmidt A, Gentilini O, Kaufman B. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA Oncol 2015; 1 (8): 1145-53.
  10. Anderson G.D. Pregnancy-indused changes in pharmacokinetics: a mechanistic-baced approach. Clin Pharmacokinet 2005; 44 (10): 989-1008.
  11. Scripture C.D, Sparreboom A, Figg W.D. Modulation of cytochrome P450 activity: implications for cancer therapy. Lancet Oncol 2005; 6 (10): 780-9.
  12. Krauer B, Dayer P, Anner R. Changes in serum albumin and alpha 1-acid glycoprotein concentrations during pregnancy: an analysis of fetal-maternal pairs. Br J Obstet Gynaecol 1984; 91 (9): 875-81.
  13. Syme M.R, Paxton J.W, Keelan J.A. Drug transfer and metabolism by the human placenta. Clin Pharmacokinet 2004; 43 (8): 487-514.
  14. Pacifici G.M, Nottoli R. Placenta transferof drugs administered to the mother. Clin Pharmacokinet 1995; 28 (3): 235-69.
  15. Nekhayeva I.A, Nanovskaya T.N, Hankins G.D, Ahmed M.S. Role of human placental efflux transporter P-glycoprotein in the transfer of buprenorphine, levo-alpha-acetylmethadol, and paclitaxel. Am J Perinatol 2006; 23 (7): 423-30.
  16. D'Incalci M, Sessa C, Colombo N et al. Transplacental passage of cyclophosphamide. Cancer Treat Rep 1982; 66 (8): 1681-2.
  17. Van Hasselt J.G, van Calsteren K, Heyns L, Han S. Optimizing anticancer drug treatment in pregnancy cancer patients: pharmacokinetic analysis of gestation-indused changes for doxorubicin, epirubicin, docetaxel and paclitaxel. Ann Oncol 2014; 25 (10): 2059-65.
  18. Eltorky M, Khare V.K, Osborne P, Shanklin D.R. Placental metastasis from maternal carcinoma. A report of three cases. J Reprod Med 1995; 40 (5): 399.
  19. Baergen R.N, Johnson D, Moore T, Benirschke K. Maternal melanoma metastatic to the placenta: a case report and review of the literature. Arch Pathol Lab Med 1997; 121 (5): 508.
  20. Wang T, Hamann W, Hartge R. Structural aspects of a placenta from a case of maternal acute lymphatic leukaemia. Placenta 1983; 4 (2): 185.
  21. Russell P, Laverty C.R. Malignant melanoma metastases in the placenta: a case report. Pathology 1977; 9 (3): 251.
  22. Sokol R.J, Hutchison P, Cowan D, Reed G.B. Amelanotic melanoma metastatic to the placenta. Am J Obstet Gynecol 1976; 124 (4): 431.
  23. Potter J.F, Schoeneman M. Metastasis of maternal cancer to the placenta and fetus. Cancer 1970; 25 (2): 380.
  24. Tsukamoto N, Kashimura Y, Sano M et al. Choriocarcinoma occurring within the normal placenta with breast metastasis. Gynecol Oncol 1981; 11 (3): 348.
  25. Choriocarcinoma of the placenta. By the OSMA Committee on Maternal Health. Ohio State Med J 1975; 71 (3): 144.
  26. Alexander A, Samlowski W.E, Grossman D et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol 2003; 21 (11): 2179.
  27. Altman J.F, Lowe L, Redman B et al. Placental metastasis of maternal melanoma. J Am Acad Dermatol 2003; 49 (6): 1150.
  28. Pavlidis N. Lung cancer during pregnancy: an emerging issue. Lung Cancer 2008; 59 (3): 279.
  29. Sebire N.J, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. Ultrasound Obstet Gynecol 2009; 33 (2): 235.
  30. Sotelo-Avila C, Graham M, Hanby D.E, Rudolph A.J. Nevus cell aggregates in the placenta. A histochemical and electron microscopic study. Am J Clin Pathol 1988; 89 (3): 395.

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