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Is chemotherapy always required for cancer in pregnancy? An observational study

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Cancer in pregnancy is relatively rare, but the incidence is increasing. Several studies show that cytotoxic agents are safe to use in pregnancy from the second trimester onwards.

Aims

This study assesses the maternal and foetal outcomes of cancers diagnosed during pregnancy. In particular, it focuses on a subset of women who elected to defer systemic chemotherapy until after delivery. This study examines if all cancers need to be treated during pregnancy or if, in certain cases, treatment can be safely deferred until after full-term delivery.

Methods

This is a retrospective observational study of women diagnosed with cancer during pregnancy in an Irish cancer centre over a 27-year period. All women diagnosed with cancer during pregnancy who were referred to the medical oncology department for consideration of chemotherapy were included in this study. Medical and pharmacy records were extensively reviewed.

Results

Twenty-five women were diagnosed with cancer in pregnancy and referred to medical oncology for consideration of systemic chemotherapy. Sixteen women (64%) commenced chemotherapy during pregnancy, seven women (28%) did not receive chemotherapy while pregnant, but commenced treatment immediately after delivery, and two (8%) did not receive any systemic chemotherapy at all. Of the seven women who commenced chemotherapy after delivery, six (85.7%) were diagnosed before 30/40 gestation. There were three cases of Hodgkin’s lymphoma, two breast cancers and one ovarian cancer. After a median follow-up of 12 years, all six mothers remain disease-free.

Conclusions

This study identified a select cohort of patients that did not receive chemotherapy during pregnancy. There were no adverse outcomes to mothers due to delayed treatment.

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References

  1. Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, Young J (2012) Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG: an international journal of obstetrics and gynaecology 119(13):1572–1582. doi:10.1111/j.1471-0528.2012.03475.x

    Article  CAS  Google Scholar 

  2. Cardonick E, Iacobucci A (2004) Use of chemotherapy during human pregnancy. The Lancet Oncology 5(5):283–291. doi:10.1016/S1470-2045(04)01466-4

    Article  CAS  PubMed  Google Scholar 

  3. Stensheim H, Moller B, van Dijk T, Fossa SD (2009) Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol Off J Am Soc Clin Oncol 27(1):45–51. doi:10.1200/JCO.2008.17.4110

    Article  Google Scholar 

  4. Peccatori FA, Azim HA Jr, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, Pentheroudakis G, Group EGW (2013) Cancer, pregnancy and fertility: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO 24(Suppl 6):vi160–vi170. doi:10.1093/annonc/mdt199

    Article  Google Scholar 

  5. European Society of Gynaecological Oncology (2015) International Network on Cancer, Infertility and Pregnancy (INCIP). http://www.cancerinpregnancy.org. Accessed 3 Feb 2015

  6. Health Research and Information Division of The Economic & Social Research Institute (2013) Perinatal Statistics Report 2012. http://www.esri.ie. Accessed 3 Feb 2015

  7. DePinho RA (2000) The age of cancer. Nature 408(6809):248–254. doi:10.1038/35041694

    Article  CAS  PubMed  Google Scholar 

  8. Amant F, Loibl S, Neven P, Van Calsteren K (2012) Breast cancer in pregnancy. Lancet 379(9815):570–579. doi:10.1016/S0140-6736(11)61092-1

    Article  PubMed  Google Scholar 

  9. Van Calsteren K, Heyns L, De Smet F, Van Eycken L, Gziri MM, Van Gemert W, Halaska M, Vergote I, Ottevanger N, Amant F (2010) Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol Off J Am Soc Clin Oncol 28(4):683–689. doi:10.1200/JCO.2009.23.2801

    Article  Google Scholar 

  10. Pereg D, Koren G, Lishner M (2008) Cancer in pregnancy: gaps, challenges and solutions. Cancer Treat Rev 34(4):302–312. doi:10.1016/j.ctrv.2008.01.002

    Article  PubMed  Google Scholar 

  11. Donegan WL (1983) Cancer and pregnancy. CA Cancer J Clin 33(4):194–214

    Article  CAS  PubMed  Google Scholar 

  12. Litton JK, Theriault RL (2010) Breast cancer and pregnancy: current concepts in diagnosis and treatment. Oncologist 15(12):1238–1247. doi:10.1634/theoncologist.2010-0262

    Article  PubMed  PubMed Central  Google Scholar 

  13. Berry DL, Theriault RL, Holmes FA, Parisi VM, Booser DJ, Singletary SE, Buzdar AU, Hortobagyi GN (1999) Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol Off J Am Soc Clin Oncol 17(3):855–861

    Article  CAS  Google Scholar 

  14. Bonnier P, Romain S, Dilhuydy JM, Bonichon F, Julien JP, Charpin C, Lejeune C, Martin PM, Piana L (1997) Influence of pregnancy on the outcome of breast cancer: a case-control study. Societe Francaise de Senologie et de Pathologie Mammaire study group. International journal of cancer Journal international du cancer 72(5):720–727

    Article  CAS  PubMed  Google Scholar 

  15. Epstein RJ (2007) Adjuvant breast cancer chemotherapy during late-trimester pregnancy: not quite a standard of care. BMC Cancer 7:92. doi:10.1186/1471-2407-7-92

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ring AE, Smith IE, Jones A, Shannon C, Galani E, Ellis PA (2005) Chemotherapy for breast cancer during pregnancy: an 18-year experience from five London teaching hospitals. J Clin Oncol Off J Am Soc Clin Oncol 23(18):4192–4197. doi:10.1200/JCO.2005.03.038

    Article  Google Scholar 

  17. Aviles A, Neri N (2001) Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clinical lymphoma 2(3):173–177

    Article  CAS  PubMed  Google Scholar 

  18. Hahn KM, Johnson PH, Gordon N, Kuerer H, Middleton L, Ramirez M, Yang W, Perkins G, Hortobagyi GN, Theriault RL (2006) Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer 107(6):1219–1226. doi:10.1002/cncr.22081

    Article  PubMed  Google Scholar 

  19. Aviles A, Neri N, Nambo MJ (2006) Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO 17(2):286–288. doi:10.1093/annonc/mdj053

    Article  CAS  Google Scholar 

  20. Loibl S, Han SN, von Minckwitz G, Bontenbal M, Ring A, Giermek J, Fehm T, Van Calsteren K, Linn SC, Schlehe B, Gziri MM, Westenend PJ, Muller V, Heyns L, Rack B, Van Calster B, Harbeck N, Lenhard M, Halaska MJ, Kaufmann M, Nekljudova V, Amant F (2012) Treatment of breast cancer during pregnancy: an observational study. The Lancet Oncology 13(9):887–896. doi:10.1016/S1470-2045(12)70261-9

    Article  CAS  PubMed  Google Scholar 

  21. Amant F, Vandenbroucke T, Verheecke M, Fumagalli M, Halaska MJ, Boere I, Han S, Gziri MM, Peccatori F, Rob L, Lok C, Witteveen P, Voigt JU, Naulaers G, Vallaeys L, Van den Heuvel F, Lagae L, Mertens L, Claes L, Van Calsteren K, International Network on Cancer I, Pregnancy (2015) Pediatric outcome after maternal cancer diagnosed during pregnancy. N Engl J Med. doi:10.1056/NEJMoa1508913

    PubMed  Google Scholar 

  22. Cardonick E, Dougherty R, Grana G, Gilmandyar D, Ghaffar S, Usmani A (2010) Breast cancer during pregnancy: maternal and fetal outcomes. Cancer J 16(1):76–82. doi:10.1097/PPO.0b013e3181ce46f9

    Article  PubMed  Google Scholar 

  23. Cardonick EH, Gringlas MB, Hunter K, Greenspan J (2015) Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls. Am J Obstet Gynecol 212(5):658. e1–e8. doi:10.1016/j.ajog.2014.11.032

  24. Morris PG, King F, Kennedy MJ (2009) Cytotoxic chemotherapy for pregnancy-associated breast cancer: single institution case series. Journal of oncology pharmacy practice: official publication of the International Society of Oncology Pharmacy Practitioners 15(4):241–247. doi:10.1177/1078155209103096

    Article  CAS  Google Scholar 

  25. Smyth EC, Korpanty G, McCaffrey JA, Mulligan N, Carney DN (2010) Small-cell carcinoma of the cervix at 23 weeks gestation. J Clin Oncol Off J Am Soc Clin Oncol 28(18):e295–e297. doi:10.1200/JCO.2009.25.5604

    Article  Google Scholar 

  26. Goodyer MJ, Ismail JR, O'Reilly SP, Moylan EJ, Ryan CA, Hughes PA, O'Connor A (2009) Safety of trastuzumab (Herceptin) during pregnancy: two case reports. Cases journal 2:9329. doi:10.1186/1757-1626-2-9329

    Article  PubMed  PubMed Central  Google Scholar 

  27. Daly PA, Donnellan P (1992) Breast cancer and pregnancy. Ir Med J 85(4):128–130

    CAS  PubMed  Google Scholar 

  28. Lynch GA (1969) Breast cancer associated with pregnancy. The Ulster medical journal 38(1):34–46

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Makgasa M, Prichard RS, Malone C, Kerin MJ (2009) Pregnancy associated breast cancer. Ir Med J 102(10):314–317

    CAS  PubMed  Google Scholar 

  30. Healy C, Dijkstra B, Kelly L, McDermott EW, Hill AD, O’Higgins N (2002) Pregnancy-associated breast cancer. Ir Med J 95(2):51–54

  31. Amant F, Van Calsteren K, Halaska MJ, Gziri MM, Hui W, Lagae L, Willemsen MA, Kapusta L, Van Calster B, Wouters H, Heyns L, Han SN, Tomek V, Mertens L, Ottevanger PB (2012) Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study. The Lancet Oncology 13(3):256–264. doi:10.1016/S1470-2045(11)70363-1

    Article  CAS  PubMed  Google Scholar 

  32. Cold S, During M, Ewertz M, Knoop A, Moller S (2005) Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish breast cancer cooperative group (DBCG). Br J Cancer 93(6):627–632. doi:10.1038/sj.bjc.6602734

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, Barnett J, Olivotto IA (2006) Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol Off J Am Soc Clin Oncol 24(30):4888–4894. doi:10.1200/JCO.2005.01.6089

    Article  Google Scholar 

  34. Buzdar AU, Smith TL, Powell KC, Blumenschein GR, Gehan EA (1982) Effect of timing of initiation of adjuvant chemotherapy on disease-free survival in breast cancer. Breast Cancer Res Treat 2(2):163–169

    Article  CAS  PubMed  Google Scholar 

  35. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH (2015) Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol 1–8. doi:10.1001/jamaoncol.2015.3856

  36. Brenner B, Avivi I, Lishner M (2012) Haematological cancers in pregnancy. Lancet 379(9815):580–587. doi:10.1016/S0140-6736(11)61348-2

    Article  PubMed  Google Scholar 

  37. Froesch P, Belisario-Filho V, Zucca E (2008) Hodgkin and non-Hodgkin lymphomas during pregnancy. Recent results in cancer research Fortschritte der Krebsforschung Progres dans les recherches sur le cancer 178:111–121

    CAS  PubMed  Google Scholar 

  38. Connors JM (2008) Challenging problems: coincident pregnancy, HIV infection, and older age. Hematology Am Soc Hematol Educ Program. 2008(1):334–339. doi:10.1182/asheducation-2008.1.334

  39. Morice P, Uzan C, Uzan S (2012) Cancer in pregnancy: a challenging conflict of interest. Lancet 379(9815):495–496. doi:10.1016/S0140-6736(11)61814-X

    Article  PubMed  Google Scholar 

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Acknowledgements

We acknowledge all those who contributed in some way to this study, including data managers and allied health professionals.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland

    E. M. Walsh, G. M. O’Kane, K. A. Cadoo, D. M. Graham, G. J. Korpanty & D. N. Carney

  2. Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    G. M. O’Kane

  3. Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY, USA

    K. A. Cadoo

  4. Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK

    D. M. Graham

  5. Department of Medical Oncology, Cork University Hospital and Mercy University Hospital, Cork, Ireland

    D. G. Power

Authors
  1. E. M. Walsh
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  2. G. M. O’Kane
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  3. K. A. Cadoo
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  4. D. M. Graham
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  6. D. G. Power
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  7. D. N. Carney
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Contributions

EM Walsh: project development, study design, data collection, data analysis, and manuscript writing and editing.

G O’Kane: study design, data collection and data analysis.

KA Cadoo: study design, data collection, data analysis and manuscript editing.

DM Graham: study design, data collection and data analysis.

GJ Korpanty: study design, data collection, data analysis and manuscript editing.

DG Power: study design, data collection and data interpretation.

DN Carney: project development, study design, data management, data analysis and manuscript editing.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to E. M. Walsh.

Ethics declarations

Conflict of interest

The listed authors declare that they have no conflict of interest to disclose.

Ethics approval

All patient data was kept strictly anonymous. Only the first and last authors listed could potentially access patient records if required. Any patient identifiers were destroyed immediately after use. For this type of study, formal consent is not required.

Funding

This study did not receive any internal or external funding, nor did the authors receive any reimbursement for their work.

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Walsh, E.M., O’Kane, G.M., Cadoo, K.A. et al. Is chemotherapy always required for cancer in pregnancy? An observational study. Ir J Med Sci 186, 875–881 (2017). https://doi.org/10.1007/s11845-017-1602-3

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  • DOI: https://doi.org/10.1007/s11845-017-1602-3

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