Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents.

Laure Benoit,Paul Berveiller,François Vialard,Olivier Mir

doi:10.3390/cancers13061238

Abstract

Simple SummaryThe use of anti-cancer treatments in pregnant women is an increasingly common situation given the increasing age at first pregnancy. The aim of this study is to review data concerning the transplacental transfer of drugs that can be used in the management of the most common pregnancy-associated cancers. This work is intended to guide clinicians in the choice of the treatments that offer the best benefit–risk ratio for the mother and the fetus and to deliver balanced information to pregnant patients.The occurrence of cancer during pregnancy is observed in 1 in 1000 pregnancies and is expected to increase given the trend of delaying childbearing. While breast cancer is the most common, the incidence of other cancers, such as cervical, ovarian, and lung cancers as well as hemopathies and melanomas, is also increasing. Thus, cancer occurrence in pregnant women raises questions of management during pregnancy and, especially, assessment of the treatment benefit–risk ratio to ensure optimal management for the mother while ensuring the safety of the fetus. Chemotherapy remains a cornerstone of cancer management. If the use of anticancer agents appears possible during pregnancy, while avoiding the first trimester, the extent of placental transfer of different anticancer agents varies considerably thereafter. Furthermore, the significant physiological pharmacokinetic variations observed in pregnant women may have an impact on the placental transfer of anticancer agents. Given the complexity of predicting placental transfer of anticancer agents, preclinical studies are therefore mandatory. The aim of this review was to provide updated data on in vivo and ex vivo transplacental transfer of anticancer agents used in the management of the most common pregnancy-associated cancers to better manage these highly complex cases.

Highlights

The concomitant occurrence of cancer and pregnancy is 1 in 1000 pregnancies [1,2,3,4].This incidence is increasing in industrialized countries owing to the trend of delaying pregnancy [5]
In view of the paucity of data on chemotherapy, targeted therapies, and immunotherapy during pregnancy, we aimed to provide a summary of the available evidence from recent literature regarding the transplacental transfer of anticancer agents used in the management of the most common pregnancy-associated cancers, using data from in vivo and ex vivo studies
Recent Guidelines on the Use of Anticancer Agents for the Treatment of Solid Tumors Most Often Associated with Pregnancy 3.1.1

Summary

Introduction

The concomitant occurrence of cancer and pregnancy is 1 in 1000 pregnancies [1,2,3,4]. This incidence is increasing in industrialized countries owing to the trend of delaying pregnancy [5]. The main parameters that influence the choice of treatment are gestational term; type and stage of cancer; the possibility of transplacental transfer and risk of teratogenicity of the drug; and the patient’s opinion on the continuation of the pregnancy if the disease is diagnosed at an early term [7]. While the treatment basis is often chemotherapy, targeted therapies and immunotherapy are becoming increasingly important in the treatment of solid cancers [8]

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