Antenatal Cancer Treatment Outcomes Reviewed

The number of cancer patients who receive treatment during pregnancy may have increased over the past 20 years

  • Date: 29 Jan 2018
  • Author: By Lynda Williams, Senior medwireNews Reporter
  • Topic: Cancer and Pregnancy

medwireNews: A 20-year review has uncovered a trend towards increased use of antenatal cancer treatment among women diagnosed with a primary invasive tumour during pregnancy.

Data from the International Network on Cancer, Infertility and Pregnancy (INCIP) were collated for 1170 patients treated at one of 37 participating centres in 16 countries between 1996 and 2016, say Frédéric Amant, from Antoni van Leeuwenhoek–Netherlands Cancer Institute in Amsterdam, and colleagues.

For each 5-year interval over the study period, the likelihood of receiving treatment during pregnancy increased by a relative risk (RR) of 1.10, the authors report in The Lancet Oncology. This increase was mainly attributed to an increase in the use of antenatal chemotherapy (RR=1.31).

In all, 88% of the 1089 singleton pregnancies recorded ended in a live birth, but data for 887 pregnancies showed that 48% ended with preterm delivery. Each 5-year interval was associated with an increase in the likelihood of live birth (RR=1.04) and a reduction in iatrogenic preterm deliveries (RR=0.91).

Further analysis indicated that receipt of platinum-based chemotherapy was linked to an increased risk of small-for-gestational-age birth weight (odds ratio [OR]=3.12), whilst use of taxane chemotherapy was associated with greater requirement for neonatal intensive care unit (NICU) admission (OR=2.37).

“We therefore recommend involving hospitals with obstetric high-care units in the management of these patients”, the researchers say. 

While the German authors of a linked comment agree with this recommendation, they believe the apparent increased use of antenatal treatment might be attributed instead to population changes in the incidence of cancer or age of pregnancy.

And discussing patient and infant outcomes, Christhardt Köhler, from Asklepios-Clinic Hamburg, and Simone Marnitz, from the University of Cologne, note that 159 of the 684 assessable patients who received treatment during pregnancy underwent surgery alone for tumours of the breast, thyroid, skin or brain that “would be unlikely to affect pregnancy outcomes.”

In addition, the commentators highlight that the impact of chemotherapy dosage was not taken into consideration, nor were the long-term risks of chemotherapy-related second malignancy in the mother and neurocognitive impairments in the children.

Frédéric Amant et al also found that the risk of NICU admission may be linked to the type of cancer. Compared with infants born to breast cancer patients, those of gastrointestinal cancer patients were the most likely to require NICU care (OR=7.13) and infants of thyroid cancer patients the least likely (OR=0.14).

Contrary to the study hypothesis, however, women who underwent abdominal or cervical surgery were not more likely to experience prelabour rupture of membranes or preterm contractions than those who did not, and “unexpectedly” their infants were less likely to require NICU care than those whose mothers did not (OR=0.30).

“This finding could be explained by the high proportion of patients with stage I disease (69%) or patients who received surgical therapy only (70%) in this group, because these patients have no potential risk factors for adverse obstetric or neonatal outcomes”, the researchers comment. 

Meanwhile, other relationships between treatment or cancer type and the likelihood of prelabour rupture of membranes or preterm contractions, small-for-gestational-age size, or need for NICU admission are "less clear", Frédéric Amant et al admit.

Christhardt Köhler and Simone Marnitz conclude that “due to its heterogeneity, the INCIP database analysis […] has minor value for women’s oncological management”. 

“Carefully planned studies combining women’s cancer-specific management in pregnancy, oncological outcomes, and long-term effects on children’s development are urgently needed to improve our limited knowledge,” they emphasize. 

References

de Haan J, Verheecke M, Van Calsteren K, et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol; Advance online publication 24 January 2018 . DOI: http://dx.doi.org/10.1016/S1470-2045(18)30059-7

Köhler C, Marnitz S. Cancer in pregnancy: evidence, or still empiricism?Lancet Oncol; Advance online publication 24 January 2018 . DOI: http://dx.doi.org/10.1016/S1470-2045(18)30058-5

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