Positive maternal, foetal outcomes possible following antenatal chemotherapy in women with cancer
Antenatal chemotherapy may not necessarily result in poor neonatal outcomes in women diagnosed with cancer during pregnancy, according to a study presented at ESMO Asia 2017.
“Results are mainly reassuring, the effect of pregnancy on the maternal outcome does not seem to be negative and [antenatal chemotherapy] is not an independent risk factor for a worse maternal outcome. We also found reassuring results on the effects of antenatal therapy on foetal safety,” said lead author Dr Jorine de Haan from the Department of Obstetrics & Gynaecology at KU Leuven, Leuven, Belgium.
Using data from the INCIP* database, researchers conducted an international cohort study involving 1,170 patients diagnosed with a primary cancer during pregnancy between 1996 and 2016. Primary outcome measures included small-for-gestational-age (SGA) and neonatal intensive care unit (NICU) admission.
Breast cancer was the most common cancer diagnosed during pregnancy (39 percent, n=462), followed by cervical cancer (13 percent, n=147), lymphoma (10 percent, n=113), ovarian cancer (7 percent, n=88), and leukaemia (6 percent, n=68).
Researchers evaluated the participants every 5 years for over 20 years. Over time, changes in oncological management and obstetrical outcome were observed, where more pregnant women with cancer were treated with chemotherapy (risk ratio [RR], 1.31) and there were more live births (RR, 1.04).
Eighty-three percent of patients underwent antenatal chemotherapy only with ≥1 chemotherapeutic agents.
There was a lower incidence of preterm births (RR, 0.93), iatrogenic preterm births (RR, 0.91), and NICU admission (RR, 0.91) among infants of patients treated with antenatal chemotherapy.
However, there was a higher likelihood of infants being small-for-gestational-age (SGA; RR, 1.16), though SGA was also associated with higher maternal age (odds ratio [OR], 1.36), systemic disease in patients diagnosed with cancer during pregnancy (OR, 1.86), and the use of platinum-based chemotherapy (OR, 3.12).
Although antenatal chemotherapy was the most common treatment given in this study, de Haan suggested that a management plan should be considered, which involves a multidisciplinary team approach in treating pregnant women diagnosed with cancer.
Further studies are warranted to elucidate the association between SGA and chemotherapy, said the researchers, who called for a long-term follow-up of children exposed to chemotherapy.
*INCIP: International Network on Cancer Infertility and Pregnancy