Chemotherapy does not appear to harm the foetus in women who have been diagnosed with cancer while pregnant, although many oncologists are still very reluctant to recommend chemotherapy for these patients.
"We hear the oncologist saying they don't want to use chemo for these patients because it might harm the foetus, but our response to that is what good does it do if you get a neonate who doesn't have a mother because she died of cancer that could have been treated," said Elyce Cardonick, MD, of the department of maternal and fetal medicine at Thomas Jefferson Medical College, in Philadelphia, Pennsylvania.
Dr. Cardonick presented the results of two studies today at the 22nd annual meeting of the Society for Maternal and Fetal Medicine (SMFM).
The initial study involved 48 women diagnosed with cancer during pregnancy (four of six women terminated the pregnancy upon physician recommendation). There were breast, thyroid, central nervous system, melanoma, Hodgkin's lymphoma, ovarian, lung, leukaemia, vulvar, cervical, and bladder cancers. All patients except one were diagnosed with a primary tumour. There was no increase in pre-term delivery and neonates did not have any growth restrictions, cancer or medical illnesses at 17 months follow-up.
Neonates had a mean gestational age at delivery of 37.4 (±2.8) weeks and a mean birth weight of 2,798 (±749) grams. Only two of the infants (4.8 percent) were less than the 10th percentile for weight at gestational age.
Of the 22 women who elected to have chemotherapy (none received radiation), most received a regimen of adriamycin/cytoxan for at least four treatment cycles. None of the women received 5-FU as base therapy, and those who were diagnosed with breast cancer were not offered tamoxifen because at that time, no studies showed that it was safe to use during pregnancy.
Chemotherapy was not started until at least the 20th week of pregnancy.
In this group of patients, none of the neonates had neutropenia, alopecia, myocarditis or rash. Aside from some women experiencing dehydration, there were no maternal complications.
One woman who had Hodgkin's lymphoma and was treated with a regimen of adriamycin/bleomycin/dacarbazine and vinblastine gave birth to a baby with syndactyly of the right hand. One woman with breast cancer gave birth to a baby with respiratory distress syndrome.
The incidence of pre-term delivery was not increased in this cohort of women, although 10 percent of the children were lower than the 10th percentile for birth weight.
There were no still births or perinatal complications.
Dr. Cardonick said that cancer in pregnancy is not a rare occurrence, and that it can be managed effectively and safely by a multi-disciplinary team.
"Chemotherapy is safe for most of these women and for their foetuses, but a lot of doctors still won't touch it," she said. Some of them are starting to come around, but there is still a lot of resistance to treating these women with chemo because they're all worried about the harm they might do to the foetus, she added.