Use of Chemotherapy During Human Pregnancy

    April 2004 in “ Lancet Oncology ”
    Elyce Cardonick, Audrey Iacobucci
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    TLDR Chemotherapy in the first trimester of pregnancy is risky, but in the second and third trimesters, it's generally safe with careful drug selection and timing.
    The document from May 2004 reviews the risks and considerations of using chemotherapy during human pregnancy. It highlights that chemotherapy during the first trimester increases the risk of spontaneous abortion, fetal death, and major malformations, while chemotherapy in the second and third trimesters has been documented as safe, with no long-term impairments in children. The review details the teratogenicity of various chemotherapeutic agents and their effects, noting that anthracyclines can cause growth restriction and fetal demise, vinca alkaloids are associated with malformations and fetal deaths, taxanes are not recommended due to embryotoxicity, and cisplatin can lead to hearing loss and other neonatal issues. The document also discusses the use of chemotherapy for specific cancers during pregnancy, emphasizing the need for careful timing and choice of agents. A follow-up of 55 pregnant patients who received chemotherapy after the first trimester showed most children developed normally, but there were two cases of periventricular leucomalacia. The study advises against chemotherapy during the maternal nadir period and after 35 weeks' gestation, and against breastfeeding during chemotherapy. The conclusion stresses the importance of balancing maternal survival with fetal risk and calls for more case publications and pharmacokinetic studies to optimize chemotherapy dosing for pregnant women.
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