Chemotherapeutic treatment of colorectal cancer in pregnancy: case report

Abstract

IntroductionColon cancer in pregnancy is uncommon. Only a small number of case reports have been published in the literature on the use of chemotherapeutic drugs during pregnancy. Reports of such cases assist clinicians in further investigating the use of chemotherapy in pregnancy.Case presentationFOLFOX-6 was administered to a pregnant, 33-year-old Saudi woman with metastatic colon cancer from 22 to 30 weeks of gestation. Her cancer was diagnosed during her pregnancy. She tolerated the chemotherapy well and delivered a full-term baby girl with no obvious harm, and normal development was documented at her 2-year follow-up examination.ConclusionColon cancer during pregnancy is not easily detected and is difficult to manage. A detailed history and high clinical suspicion are needed in patients who present with symptoms and signs suggestive of malignancy. A multidisciplinary approach with patient involvement is needed to decrease morbidity and mortality caused by both treatment and the cancer in the mother and to limit side effects for the fetus. Further data and long-term follow-up are needed to better understand the potential long-term side effects of chemotherapeutic drugs on offspring.

Evolution of Colon Cancer and Pregnancy: A Report of Two Cases

“…From an obstetrical point of view, both the timely and safe resolution of childbirth and fetal well-being must be ensured in the sense that neither the cancer nor its treatment seriously affects the condition of the fetus and the newborn. Obviously, is not wise to administrate chemotherapy during first trimester, but there are a lot of drugs that can be used after fetal development [10,11]. The most important complication could be a fetal growth restriction, but, while it would be only a restriction and not a lack of fetal growth and the Doppler evaluations reassured the fetal state, is possible to continue the pregnancy to the most advanced gestational age as possible, as we have done with this two cases of colon cancer and we have done with other cancers, specially breast cancer and pregnancy.…”

“…There are few reports about these cases. Makoshi et al [2] reported a case treated with FOLFOX-6 to a pregnant woman between 22 and 30 gestational weeks. The patient tolerated well the treatment and was delivered of a term newborn without any harm.…”

The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges

“…Cetuximab, panitumumab, bevacizumab, ramucirumab, and ziv-aflibercept are IgG subclass monoclonal antibodies or fusion proteins and may follow this same fetal exposure pattern [7, 37, 49-51, 53, 54]. [20,21,47,48] 587-677.19 (SN-38 5 392) D Human data: 2 cases given 5-FU in 2nd and 3rd trimester report no congenital malformations Animal data: embryotoxic, teratogenic, decreased learning, and low birth weights Oxaliplatin [15][16][17][18][19]46] 397.3 D Human data: 5 cases given 5-FU in 2nd and 3rd trimester report limited congenital malformations (1 case of hypothyroidism) Animal data: embryo-fetal toxicity and teratogenic Bevacizumab [37,49] 149,000 C Human data: no i.v. administration data Animal data: teratogenic, fetal resorptions, reduced maternal and fetal weights Ziv-Aflibercept [50] 97,000 C Human data: none Animal data: embryo-fetal toxicity and teratogenic effects Cetuximab [37,53] 152,000 C Human data: none Animal data: embryolethal and abortifacient effects Panitumumab [37,54] 147,000 C…”

“…A concern with extrapolation from these cases is the route of administration; bolus dosing is used with FAC, whereas 5-FU in CRC is given as both a bolus and continuous infusion. No congenital abnormalities, except for hypothyroidism, were found in 8 pregnant women with CRC who received 5-FU alone or in combination (with oxaliplatin or irinotecan) after the first trimester (Table 3) [15][16][17][18][19][20][21][22]. Capecitabine was given in one case of CRC during pregnancy, along with oxaliplatin, in the first trimester [13, 23].…”

“…Colorectal cancer (CRC) during pregnancy is rare, with an incidence of 1 in 13,000 pregnancies [2,10,14]. Although infrequent, CRC cases during pregnancy have been reported in the past decade [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. With thetrendindelayedchild-bearing,theraresituationofCRCduring pregnancy will likely rise in incidence.…”