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Management onkologischer Erkrankungen in der Schwangerschaft

Management of cancer diseases in pregnancy

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Zusammenfassung

Maligne Erkrankungen treten bei 1–2 von 1000 Schwangerschaften auf. Entscheidend für das therapeutische Vorgehen ist das Stadium der Schwangerschaft. Während unter einer systemischen Tumortherapie im 1. Trimenon eine erhöhte Rate nachfolgender Fehlbildungen und Fehlgeburten zu erwarten ist, kann bei gegebener Indikation ab dem 2. Trimenon eine medikamentöse Tumortherapie unter Beachtung spezieller Kontraindikationen sicher durchgeführt werden. Dabei werden die eingesetzten Substanzen in der Standarddosis verabreicht. Tyrosinkinaseinhibitoren, Antikörper gegen den (vaskulären) endothelialen Wachstumsfaktor, antihormonelle Substanzen oder Immuncheckpoint-Inhibitoren sind im gesamten Schwangerschaftsverlauf kontraindiziert. Die im Rahmen supportiver Maßnahmen verwendeten Substanzen wie Antiemetika (mit Ausnahme von Aprepitant), Granulozyten-Kolonie-stimulierender Faktor, niedermolekulare Heparine oder Standardantibiotika sind ganz überwiegend im 2. und 3. Trimenon sicher einsetzbar. Außer beim Zervixkarzinom wird eine normale Entbindung zum üblichen Termin angestrebt, wobei zwischen myelosuppressiver Chemotherapie und Entbindung eine ausreichende Erholungszeit eingeplant werden sollte.

Abstract

Malignancies emerging in pregnant women are rare. Between one and two in 1000 pregnancies are affected. Systemic anticancer drugs can be administered during the second and third trimester, typically using standard chemotherapy protocols. Multiple agents are contraindicated throughout the pregnancy, e.g., tyrosine kinase inhibitors and other molecularly targeted drugs, antihormonal drugs or immune checkpoint inhibitors. The majority of supportive agents such as antiemetics (with the exception of aprepitant), granulocyte colony-stimulating factor, heparin preparations or standard antibiotics may also be used safely. A normal duration of pregnancy and a normal delivery should be sought, while a section delivery is only preferred in the case of advanced cervical cancer.

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Authors and Affiliations

  1. Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie (DGHO) e. V., Alexanderplatz 1, 10178, Berlin, Deutschland

    Georg Maschmeyer

  2. German Breast Group, Frankfurt/Main, Deutschland

    Sibylle Loibl

  3. Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland

    Sibylle Loibl

  4. GBG Forschungs GmbH, Neu-Isenburg, Deutschland

    Sibylle Loibl

  5. Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    Tanja Fehm

  6. Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland

    Inken Hilgendorf

  7. Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    Ralf Dittrich

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  1. Georg Maschmeyer
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Correspondence to Georg Maschmeyer.

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Interessenkonflikt

G. Maschmeyer: Honorare für Vorträge und/oder Moderation von Symposien: Merck-Serono, Gilead Sciences, AstraZeneca, Janssen-Cilag, GlaxoSmithKline, Forum für Medizinische Fortbildung, RG Medizinische Fortbildung, MedUpdate, Uniklinik Kiel, Uniklinik Leipzig, Landesapothekerkammer Baden-Württemberg, OSHO Services; Reisekostenunterstützung durch Janssen-Cilag. S. Loibl, T. Fehm, I. Hilgendorf und R. Dittrich geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Maschmeyer, G., Loibl, S., Fehm, T. et al. Management onkologischer Erkrankungen in der Schwangerschaft. Forum 38, 16–21 (2023). https://doi.org/10.1007/s12312-022-01134-z

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