2156P - Use of taxanes during pregnancy: A systematic review

Background

The use of chemotherapy (CT) with taxanes after the first trimester of pregnancy is endorsed by guidelines despite limited data on their safety. This study aims to review the neonatal and obstetric outcomes after the use of taxanes during pregnancy.

Methods

A MEDLINE search was performed up to 1/1/2023. Inclusion criteria included gestational taxane use, original findings, and reporting of individual patient outcomes.

Results

A total of 69 out of 316 references identified were included. Overall, 143 cases of gestational taxane use have been reported in the literature, resulting in 145 fetuses exposed in utero. Most received paclitaxel (78%) and were diagnosed with breast (59%), cervix (23%), or ovarian (13%) malignancies. Taxanes were initiated most frequently in the 2nd (69%) or 3rd trimesters (28%) of pregnancy (n=110), at a median gestational age of 17 weeks (range 2-32; n=89). The median cumulative dose received during pregnancy was 405 mg/m2 (range: 125-1200; n=63) for paclitaxel and 320 mg/m2 (range: 160-650; n=12) for docetaxel. Out of 107 cases, 91% received other CT agents during pregnancy, including platinums (50.4%) or doxorubicin/cyclophosphamide (17.8%). No maternal adverse events or obstetric complications were reported in 54% (41/97). The most frequent adverse obstetric events were preterm contractions (12/121; 10%), pre-eclampsia (6/97; 6%), intrauterine growth restriction (7/97; 7%), oligohydramnios (5/97; 5%), and preterm premature rupture of membranes (6/120; 5%). All cases with data available resulted in live birth (n=117). Preterm birth was reported in 63% (82/131) and 29% of neonates were classified as small for gestational age (36/123). Perinatal complications were documented in 18% (20/109), including one case of neonatal death secondary to multiple congenital malformations that had been detected before CT start. A congenital malformation was reported in 4% (6/142). Information of health status after birth was available for 85 cases (median follow-up 19 months, range 1 to 160), of which 87% were reported as healthy. Two cases of pediatric malignancy were noted.

Conclusions

Data on gestational taxane use is largely limited to case reports and small case series with heterogeneous reporting of outcomes. Future studies are urgently needed to evaluate their safety.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.