Skip to main content

Advertisement

Log in

Neoadjuvant chemotherapy with paclitaxel plus platinum for invasive cervical cancer in pregnancy: two case report and literature review

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Cervical cancer (including carcinoma in situ) is the most common malignancy during pregnancy. Neoadjuvant chemotherapy (NACT) with paclitaxel plus cisplatin has been used in patients with cervical cancer successfully, but experience of its prenatal treatment is limited.

Case report

We report two pregnant women with locally advanced cervical cancer. They were treated with cisplatin plus paclitaxel NACT until fetal pulmonary maturity was achieved, and then accepted cesarean section followed by radical hysterectomy. To minimize the chemo-resistant/radio-resistant tumor cell clones and increase the potencies of NACT, we modified the dose of the chemotherapeutic agents and the treatment interval using cisplatin (50 mg/m2) and paclitaxel (75 mg/m2) every 2 weeks. Evaluation for clinical response to chemotherapy displayed a partial and complete response, respectively. Both patients had not had any evidence of recurrence for 21 and 13 months. Their children did not have any evidence of malformations and showed normal development at 21 and 13 months of follow-up, respectively.

Conclusion

Neoadjuvant chemotherapy with paclitaxel plus cisplatin appears to be feasible and safe for pregnant patients with invasive cervical cancer and infants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

References

  1. Nguyen C, Montz FJ, Bristow RE (2000) Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv 55(10):633–643

    Article  PubMed  CAS  Google Scholar 

  2. Boyd A, Cowie V, Gourley C (2009) The use of cisplatin to treat advanced-stage cervical cancer during pregnancy allows fetal development and prevents cancer progression: report of a case and review of the literature. Int J Gynecol Cancer 19(2):273

    Article  PubMed  Google Scholar 

  3. Jones WB, Shingleton HM, Russell A et al (1996) Cervical carcinoma and pregnancy. A national patterns of care study of the American College of Surgeons. Cancer 77(8):1479–1488

    Article  PubMed  CAS  Google Scholar 

  4. Rose P, Blessing J, Gershenson D et al (1999) Paclitaxel and cisplatin as first-line therapy in recurrent or advanced squamous cell carcinoma of the cervix: a Gynecologic Oncology Group Study. J Clin Oncol 17(9):2676

    PubMed  CAS  Google Scholar 

  5. Papadimitriou C, Sarris K, Moulopoulos L et al (1999) Phase II trial of paclitaxel and cisplatin in metastatic and recurrent carcinoma of the uterine cervix. J Clin Oncol 17(3):761

    PubMed  CAS  Google Scholar 

  6. Chun KC, Kim DY, Kim JH et al (2010) Neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical surgery in early cervical cancer during pregnancy: three case reports. Jpn J Clin Oncol 40(7):694–698

    Article  PubMed  Google Scholar 

  7. Ishioka S, Ezaka Y, Endo T et al (2009) Outcomes of planned delivery delay in pregnant patients with invasive gynecologic cancer. Int J Clin Oncol 14(4):321–325

    Article  PubMed  Google Scholar 

  8. Karam A, Feldman N, Holschneider CH (2007) Neoadjuvant cisplatin and radical cesarean hysterectomy for cervical cancer in pregnancy. Nat Clin Pract Oncol 4(6):375–380

    Article  PubMed  CAS  Google Scholar 

  9. Latimer J (2007) Gynaecological malignancies in pregnancy. Curr Opin Obstet Gynecol 19(2):140–144

    Article  PubMed  Google Scholar 

  10. Sood AK, Sorosky JI (1998) Invasive cervical cancer complicating pregnancy. How to manage the dilemma. Obstet Gynecol Clin North Am 25(2):343–352

    Article  PubMed  CAS  Google Scholar 

  11. Van Calsteren K, Vergote I, Amant F (2005) Cervical neoplasia during pregnancy: diagnosis, management and prognosis. Best Pract Res Clin Obstet Gynaecol 19(4):611–630

    Article  PubMed  Google Scholar 

  12. Sardi JE, Giaroli A, Sananes C et al (1997) Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol 67(1):61–69

    Article  PubMed  CAS  Google Scholar 

  13. Hwang YY, Moon H, Cho SH et al (2001) Ten-year survival of patients with locally advanced, stage ib–iib cervical cancer after neoadjuvant chemotherapy and radical hysterectomy. Gynecol Oncol 82(1):88–93

    Article  PubMed  CAS  Google Scholar 

  14. Caluwaerts S, Van CK, Mertens L et al (2006) Neoadjuvant chemotherapy followed by radical hysterectomy for invasive cervical cancer diagnosed during pregnancy: report of a case and review of the literature. Int J Gynecol Cancer 16(2):905–908

    Article  PubMed  CAS  Google Scholar 

  15. Tewari K, Cappuccini F, Gambino A et al (1998) Neoadjuvant chemotherapy in the treatment of locally advanced cervical carcinoma in pregnancy: a report of two cases and review of issues specific to the management of cervical carcinoma in pregnancy including planned delay of therapy. Cancer 82(8):1529–1534

    Article  PubMed  CAS  Google Scholar 

  16. Rabaiotti E, Sigismondi C, Montoli S et al (2010) Management of locally advanced cervical cancer in pregnancy: a case report. Tumori 96(4):623–626

    PubMed  Google Scholar 

  17. Lahousen M, Pickel H, Haas J (1988) Adjuvant chemotherapy after radical hysterectomy for cervical cancer. Baillieres Clin Obstet Gynaecol 2(4):1049–1057

    Article  PubMed  CAS  Google Scholar 

  18. Grigsby PW (2001) Cervical cancer: combined modality therapy. Cancer J 7(Suppl 1):S47–S50

    PubMed  Google Scholar 

  19. Giardina G, Richiardi G, Danese S et al (1997) Weekly cisplatin as neoadjuvant chemotherapy in locally advanced cervical cancer: a well-tolerated alternative. Eur J Gynaecol Oncol 18(3):173–176

    PubMed  CAS  Google Scholar 

  20. Timotheadou E, Gore ME (2003) Neoadjuvant chemotherapy for locally advanced cervical cancer. Eur J Cancer 39(17):2419–2421

    Article  PubMed  CAS  Google Scholar 

  21. Rew DA, Wilson GD (2000) Cell production rates in human tissues and tumours and their significance. Part II: clinical data. Eur J Surg Oncol 26(4):405–417

    Article  PubMed  CAS  Google Scholar 

  22. Bolger BS, Symonds RP, Stanton PD et al (1996) Prediction of radiotherapy response of cervical carcinoma through measurement of proliferation rate. Br J Cancer 74(8):1223–1226

    Article  PubMed  CAS  Google Scholar 

  23. Loizzi V, Cormio G, Vicino M et al (2008) Neoadjuvant chemotherapy: an alternative option of treatment for locally advanced cervical cancer. Gynecol Obstet Invest 65(2):96–103

    Article  PubMed  CAS  Google Scholar 

  24. Gonzalez-Martin A, Gonzalez-Cortijo L, Carballo N et al (2008) The current role of neoadjuvant chemotherapy in the management of cervical carcinoma. Gynecol Oncol 110(3 Suppl 2):S36–S40

    Article  PubMed  Google Scholar 

  25. Cho YH, Kim DY, Kim JH et al (2009) Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer. J Gynecol Oncol 20(1):22–27

    Article  PubMed  Google Scholar 

  26. Mir O, Berveiller P, Ropert S et al (2008) Use of platinum derivatives during pregnancy. Cancer 113(11):3069–3074

    Article  PubMed  CAS  Google Scholar 

  27. Marnitz S, Kohler C, Oppelt P et al (2010) Cisplatin application in pregnancy: first in vivo analysis of 7 patients. Oncology 79(1–2):72–77

    Article  PubMed  CAS  Google Scholar 

  28. Cardonick E, Iacobucci A (2004) Use of chemotherapy during human pregnancy. Lancet Oncol 5(5):283–291

    Article  PubMed  CAS  Google Scholar 

  29. Scialli A, Desesso J, Goeringer G (2005) Taxol and embryonic development in the chick. Teratog Carcinog Mutagen 14(1):23–30

    Article  Google Scholar 

  30. Sood AK, Shahin MS, Sorosky JI (2001) Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy. Gynecol Oncol 83(3):599–600

    Article  PubMed  CAS  Google Scholar 

  31. Mendez LE, Mueller A, Salom E et al (2003) Paclitaxel and carboplatin chemotherapy administered during pregnancy for advanced epithelial ovarian cancer. Obstet Gynecol 102(5 Pt 2):1200–1202

    Article  PubMed  Google Scholar 

  32. Gadducci A, Cosio S, Fanucchi A et al (2003) Chemotherapy with epirubicin and paclitaxel for breast cancer during pregnancy: case report and review of the literature. Anticancer Res 23(6):5225–5229

    PubMed  Google Scholar 

  33. Gonzalez-Angulo AM, Walters RS, Carpenter RJ Jr et al (2004) Paclitaxel chemotherapy in a pregnant patient with bilateral breast cancer. Clin Breast Cancer 5(4):317–319

    Article  PubMed  Google Scholar 

  34. Lycette JL, Dul CL, Munar M et al (2006) Effect of pregnancy on the pharmacokinetics of paclitaxel: a case report. Clin Breast Cancer 7(4):342–344

    Article  PubMed  Google Scholar 

  35. Bader AA, Schlembach D, Tamussino KF et al (2007) Anhydramnios associated with administration of trastuzumab and paclitaxel for metastatic breast cancer during pregnancy. Lancet Oncol 8(1):79–81

    Article  PubMed  Google Scholar 

  36. Mantovani G, Gramienano G, Mais V et al (2007) Use of chemotherapy for ovarian cancer during human pregnancy: case report and literature review. Eur J Obstet Gynecol Reprod Biol 131(2):238–239

    Article  PubMed  Google Scholar 

  37. Hubalek M, Smekal-Schindelwig C, Zeimet AG et al (2007) Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma. Arch Gynecol Obstet 276(2):179–183

    Article  PubMed  Google Scholar 

  38. Modares Gilani M, Karimi Zarchi M, Behtash N et al (2007) Preservation of pregnancy in a patient with advanced ovarian cancer at 20 weeks of gestation: case report and literature review. Int J Gynecol Cancer 17(5):1140–1143

    Article  PubMed  CAS  Google Scholar 

  39. Azim HA Jr, Scarfone G, Peccatori FA (2009) Carboplatin and weekly paclitaxel for the treatment of advanced non-small cell lung cancer (NSCLC) during pregnancy. J Thorac Oncol 4(4):559–560

    Article  PubMed  Google Scholar 

  40. Doi D, Boh Y, Konishi H et al (2009) Combined chemotherapy with paclitaxel and carboplatin for mucinous cystadenocarcinoma of the ovary during pregnancy. Arch Gynecol Obstet 280(4):633–636

    Article  PubMed  Google Scholar 

  41. Morris PG, King F, Kennedy MJ (2009) Cytotoxic chemotherapy for pregnancy-associated breast cancer: single institution case series. J Oncol Pharm Pract 15(4):241–247

    Article  PubMed  CAS  Google Scholar 

  42. Garcia-Gonzalez J, Cueva J, Lamas MJ et al (2008) Paclitaxel and cisplatin in the treatment of metastatic non-small-cell lung cancer during pregnancy. Clin Transl Oncol 10(6):375–376

    Article  PubMed  CAS  Google Scholar 

  43. Palaia I, Pernice M, Graziano M et al (2007) Neoadjuvant chemotherapy plus radical surgery in locally advanced cervical cancer during pregnancy: a case report. Am J Obstet Gynecol 197(4):e5–e6

    Article  PubMed  Google Scholar 

  44. Monk BJ, Sill MW, McMeekin DS et al (2009) Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 27(28):4649–4655

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zhong-qiu Lin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, J., Wang, Lj., Zhang, Bz. et al. Neoadjuvant chemotherapy with paclitaxel plus platinum for invasive cervical cancer in pregnancy: two case report and literature review. Arch Gynecol Obstet 284, 779–783 (2011). https://doi.org/10.1007/s00404-011-1943-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-011-1943-5

Keywords

Navigation