Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study

Abstract

ObjectiveTo describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy.MethodsA multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes.ResultsThirty-three patients were included. Median age was 34 years (range 31–36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA–IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34–36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0–36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease.ConclusionNeoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.

Neoadjuvant Chemotherapy in Pregnant Patients with Cervical Cancer: A Monocentric Retrospective Study

“…Interestingly, the only patient who died of disease was the only one who received monochemotherapy with cisplatin and radical surgery following the cesarean section. The available, retrospective cohort studies confirm the excellent oncological outcomes of patients treated in pregnancy with NACT and CRH [ 12 , 13 ]. The outcomes of patients who decided to continue the pregnancy seems to be comparable to that of patients who chose to terminate it, and the prognosis of pregnant and non-pregnant patients seems to be similar [ 8 ].…”

“…To date, little and discordant data still exist in the literature on the management of CC in pregnancy, with considerable heterogeneity in terms of treatment, CT schedules, timing, and surgical procedures [ 7 , 9 , 11 , 12 , 13 ].…”

“…In this scenario, neo-adjuvant chemotherapy (NACT) has been shown to be a valid therapeutic option for patients with CC, allowing, on one hand, an acceptable control of neoplastic progression, and on the other, a delay of delivery until the fetus has reached a maturity that guarantees its viability outside the maternal uterus [ 7 , 10 ]. Despite the availability of ESMO guidelines (2019) on the management of cancer during pregnancy [ 5 ], these are currently based on limited data from expert opinions and a small number of cases [ 7 , 9 , 11 , 12 , 13 ].…”

Clinical analysis of cervical cancer in the second and third trimesters of pregnancy

“…Studies have found that early pregnancy chemotherapy is not associated with increased congenital abnormalities, while chemotherapy in mid to late pregnancy is associated with fetal growth restriction, low birth weight, and preterm labor (Mandic, et al,2020). However, several studies have shown that neoadjuvant chemotherapy in mid to late pregnancy is safe (Sparano, et al,2008;Zagouri, et al,2019) and is an effective alternative for achieving fetal survival (Lopez, et al,2021). Neoadjuvant chemotherapy can control tumor progression, delay the pregnancy week, promote fetal lung maturation, ensure maternal and fetal survival, and prevent lesion transfer during pregnancy (Mandic, et al,2020;Bernardini, et al,2022).Therefore, neoadjuvant chemotherapy is safe and effective in pregnant women with cervical cancer.…”

The efficacy and safety of platinum-based chemotherapy for ovarian cancer in pregnancy: A protocol for systematic review and meta-analysis

“…All chemotherapy agents are potentially teratogenic and there is a potential long-term effect on the offspring. [15] The key factor in this situation is the relationship between the doctor's conscience and the patient's trust. [16] Decisions concerning the choice of the best management of ovarian cancer are very complex and difficult because of the conflict between the mother's and the fetus's wellbeing [17] ; thus, a multidisciplinary team consisting of an obstetrician, oncologist, pathologist, anesthesiologist, neonatologist and psychologist is mandatory.…”