FOLFOXIRI in Pregnant Women with Colorectal Cancer: A Case Report and Review of the Literature

Abstract

Colorectal cancer (CRC) in pregnancy is rare and often presents at a late stage due to the masking of signs by pregnancy. A typical chemotherapeutic regimen for stage III and IV CRC comprised 5-Fluorouracil (5-FU) and oxaliplatin. The treatment of CRC during pregnancy is complicated owing to the potential risk of teratogenicity with chemotherapy, especially in the first trimester. Data suggest that the administration of chemotherapy beyond the first trimester may be relatively safe. Previous reports have shown success with the use of FOLFOX (folinic acid, 5-FU, oxaliplatin) and FOLFIRI (folinic acid, 5-FU, irinotecan) during pregnancy. Moreover, neoadjuvant FOLFOXIRI (folinic acid, 5-FU, oxaliplatin, irinotecan) resulted in improved outcomes when compared to standard preoperative chemoradiotherapy in the treatment of locally advanced and metastatic CRC. The use of FOLFOXIRI in pregnancy is not currently documented, and therefore, the outcomes of using this chemotherapeutic regimen are unclear. The aim of this case report was to demonstrate the use of FOLFOXIRI in pregnancy. A retrospective chart review was performed to assess the clinical course and fetal outcome of 2 patients presented in this case report. FOLFOXIRI was initiated in two pregnant women with nonmetastatic and metastatic CRC, resulting in successful delivery of healthy infants. FOLFOXIRI is an effective chemotherapy regimen for the treatment of advanced CRC and may be used during the second and third trimesters of pregnancy.

Diagnosis and Treatment of Metastatic Colon Cancer in Pregnancy First Presenting as Multiple Liver Masses: A Case Report

“…Numerous cases of human 5-FU exposure in pregnancy exist, with most cases occurring in breast cancer treatment [ 13 ]. The overall rate of major malformations when the FOLFOXIRI regimen was administered in the second or third trimester was not significantly different from that in the general population [ 14 ]. Chemotherapy was not administered because she was close to 35 weeks of gestation, and chemotherapy is usually only continued until 35 weeks of gestation or 3 weeks before the expected due date to avoid the risk of chemotherapy-related complications, such as bone marrow suppression and hemorrhage, during delivery.…”

Colon Cancer and Pregnancy

“…with the same protocols as one would follow for a nongravid patient. 27,[33][34][35][36][37] In specific cases, the mother may decline pregnancy termination or treatment may be appropriate despite early gestational age. 32 There are case reports illustrating successful treatment, with considerably little harm to the fetus.…”

“…Thus, the overarching recommendation is to offer termination of the pregnancy and to treat the mother expediently and definitively with the same protocols as one would follow for a nongravid patient. 27 33 34 35 36 37…”