Priorities and uncertainties of administering chemotherapy in a pregnant woman with newly diagnosed colorectal cancer

Abstract

Background. The absence of treatment standards for the use of chemotherapy in pregnancy is due, in part, to the fact that cancer in the gravid female is relatively uncommon. Method. A case (of a pregnant woman with newly diagnosed colorectal cancer) is presented to explore this area of medical uncertainty. Result. Managed by a multi-disciplinary team, successful prolongation of gestation was achieved with an oxaliplatin-based chemotherapy regimen. Conclusion. A perspective of the ongoing conflict between prolonging the mother's life and preserving fetal development is highlighted. Although not life-saving, administration of chemotherapy in this woman was life-sparing. J Oncol Pharm Practice (2009) 15: 5—8.

Chemotherapeutic treatment of colorectal cancer in pregnancy: case report

“…Gestational age at initiation of chemotherapy ranged from 13 weeks [5] to 24 weeks [4], and all reported positive fetal outcomes. The follow-up periods ranged from 11¾ months [4] to 3½ years [3], and all children were reported to be within the normal limits for height, weight and neurological development. The mothers were started on FOLFIRI regimes once delivery had occurred, and two underwent surgical resection [3, 5].…”

“…The mothers were started on FOLFIRI regimes once delivery had occurred, and two underwent surgical resection [3, 5]. Maternal outcomes varied from being disease-free at 1 year [3], dying 1 year after diagnosis (6 months post-delivery) [4] and dying 5 months after diagnosis (16 weeks post-delivery) [5]. Only one recent case report [6] included in our present literature review described use of the FOLFIRI regime, consisting of irinotecan, leucovorin and 5-FU, during pregnancy, followed by FOLFOX post-delivery.…”

“…Less positive maternal outcomes were reported in two cases [4, 5]. Only one study reported the mother to be disease-free at 1 year [3].…”

Synchronous colorectal liver metastases in pregnancy and post‐partum

“…7,8 Reported risks of active treatment during pregnancy include teratogenicity, intra-uterine fetal demise and placental abruption. 3 Other studies suggest surgical and chemotherapy treatments as having acceptable morbidity and mortality risk for the unborn child while also improving maternal survival. 1 This study reports five cases of synchronous primary CRC with liver metastases (sCRLM) diagnosed during pregnancy or postpartum, highlighting the importance of early investigation of symptomatic patients during pregnancy, as well as the role of chemotherapeutic, radiological and surgical interventions.…”

“…1 Metastatic colorectal cancer (mCRC) is rare, occurring in approximately 0.002% of pregnancies. [1][2][3] However, epidemiological data indicate an increased incidence of colorectal cancer (CRC) diagnosed in pregnancy and post-partum of 26% over the last 10 years, due, at least in part, to more women falling pregnant at an advanced maternal age. 1,4 Common presenting symptoms include abdominal pain or mass, constipation, nausea and vomiting, weight loss and rectal bleeding.…”