CCoPE
Date: 2004-06-24

Question:
Dear colleages, I write you requiring a consultation about the cytotoxic treatment during pregnancy. Our patient underwent surgical treatment for the breast cancer. Lymphatic nodes were positive for metastasis, therefore chemotherapy with doxorubicin, cyclophosphamid, and docetaxel is planed on 20week of her pregnancy.

We suppose there is relatively low risk for great malformations, but we cannot exclude IUGR, miscarriege,panmyelopenia, functional changes including mental retardation, infertility and cancer in adult of exposed child What are you recommending for this case. How high risk can be estimated for her pregnancy?

Thank you for your help.

Answer:
Based on the information you have provided we would suggest that the risk of malformation in the 20th week of pregnancy is not greater than the risk in healthy women. The risk of IUGR and miscarriage is substantial and the woman needs close followup-however this should not preclude the administration of chemotherapy.

The delivery should be planned for the time that the fetus will not be at risk of pancytopenia. There are no long term known risks for second malignancies,infertility or neurological maldevelopment.

A word of caution: there is a relatively small amount of data re taxanes in pregnancy.