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

Abstract

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.

Prevalence of Human Papillomavirus and Genotype Distribution in Pregnant and Non-Pregnant Women in China

“…3 Cervical lesions are common in pregnant women; therefore, routine cervical cancer screening is very important in this specific population. 4 However, it is difficult to screen and diagnose cervical lesions in pregnant women for two main reasons:1) Pregnancy changes the shape of the cervix, making it more difficult to collect specimens, and specimen collection requires extra staff; and 2) some women refuse to allow sample collection because of concern about the risk of miscarriage and premature delivery, particularly among women who have experienced vaginal bleeding during pregnancy.…”

Fetal biometric and Doppler measurements following abdominal radical trachelectomy in the second trimester of the pregnancy

“…Neoadjuvant chemotherapy (NAC) is another treatment option for pregnant women with early-stage cervical cancer. As NAC has been administered during pregnancy to patients with various types of cancers, such as breast cancer [ 27 ], there are more data available regarding the influence of NAC on fetal and perinatal outcomes than that of ART-DP [ 28 ] Schwab et al noted that chemotherapy during the second and third trimesters is considered relatively safe but increases the risk of preeclampsia and fetal growth restriction [ 29 ]. They noted the preterm birth rate was 48, and 12% of those births spontaneously occurred.…”

Chronic lymphocytic leukemia diagnosed during pregnancy - case report and review of literature

“…In the matter of chemotherapy in pregnancy, 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, but also the patient's opinion on the continuation of the pregnancy if the disease is diagnosed at an early term [21]. The fetus is most vulnerable to drug-related teratogenicity during the first trimester, and consequently chemotherapeutic agents, especially genotoxic drugs in combination, should be avoided.…”