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

Abstract

Cancer diagnosed during pregnancy has increased because of delayed child-bearing and the known occurrence of agedependent malignancies. Cases of colorectal cancer (CRC) in pregnancy have recently been reported. With the expected rise in CRC diagnosed in young adults coupled with the current trend of delayed child-bearing, CRC during pregnancy is likely to increase. Treating pregnant women with CRC by using antineoplastics presents a dilemma because there are many unknowns to guide treatment decisions. We review the issues regarding the use of 10 CRC-approved agents in pregnancy. The Oncologist 2016; 21:563-570Implications for Practice: Colorectal cancer (CRC) in pregnancy is likely to become more common because of the current population trend in delayed child-bearing and the increase in CRC incidence expected among young adults. Practitioners should become familiar with the challenges associated with systemic treatment of a pregnant patient with CRC. This review addresses concerns surrounding the 10 systemic agents approved for CRC to help provide treatment guidance when such a case arises.

Chemotherapy During Pregnancy for Advanced Colon Cancer: A Case Report

“…[10][11][12][13][14][15] Overviews of the challenges of chemotherapy during pregnancy provide valuable guidance. 8,19,20 Because the patient's need for treatment contrasts with the child's challenges by being prematurely delivered, interdisciplinary cooperation is necessary, including surgeons, oncologists, and obstetricians.…”

“…A comprehensive review of chemotherapy for CRC discussed the different drugs in detail and reported on outcomes and safety of published case reports. 8 A monograph on the developmental effects and pregnancy outcomes associated with chemotherapy during pregnancy reports on several individual chemotherapeutics. 25 These publications, along with the case reports, were valuable for guiding the treatment decision of the reported patient, who started chemotherapy with a FOLFOX regimen toward the end of the second trimester.…”

“…Growth factors such as epidermal growth factor and vascular endothelial growth factor are of importance for fetal growth and maintenance of pregnancy, and there is a lack of reports on human exposure; therefore, treatment with monoclonal antibodies against epidermal growth factor receptor or vascular endothelial growth factor should be avoided during pregnancy. 8,25 A recent review suggests treatment algorithms of surgery and chemotherapy for CRC in pregnancy. 19 The International Network on Cancer, Infertility and Pregnancy 26 database has reported 41 patients with CRC during pregnancy; 12 received chemotherapy during the second or third trimester of pregnancy.…”

“…7 With increased cancer incidence and delayed child-bearing, the occurrence of CRC during pregnancy is expected to increase. 8 Although rare, CRC in young adults has large impact on life and multiple aspects of quality of life. 9 A diagnosis of CRC during pregnancy imposes therapeutic challenges in addition to major psychosocial issues.…”

“…For CRC, there are some case reports, [10][11][12][13][14][15][16][17] patient series, 18 and literature reviews 8,19,20 of chemotherapy during pregnancy; most have reported on treatment with 5-fluorouracil (5-FU) and oxaliplatin (FOLFOX). 8,[10][11][12][13][14][15]17,18 Case reports of patients treated with FOLFOX during pregnancy for metastatic colorectal cancer are shown in Table 1. Although CRC during pregnancy is often diagnosed at a more advanced stage, patient survival has been reported to be comparable with that in nonpregnant patients.…”