Cancer and Pregnancy 2012
Highlights of the first Cancer and Pregnancy Meeting
Dr Fedro Peccatori – European Institute of Oncology, Milan, Italy

We had one and a half days of wonderful scientific sharing and we discussed treatments, modalities, in pregnant cancer patients; we discussed surgical treatment of those patients; we discussed the follow-up of the babies whose mother had been treated with chemotherapy during pregnancy and those are new data. The last day we also had a kind of insight into the psychological issues that those patients have to face. Professor Frederic Amant presented the update of his series of seventy babies who were born after their mothers received chemotherapy during pregnancy. The good news is that those babies had very good psychomotorial development, neurodevelopment, and they didn’t have any autotoxicity which was of concern, they didn’t have any cardiac toxicity, which again was one of the concerns.

The interesting information, though, was that for babies who were born prematurely, also those that were not born very prematurely, so what we called the late pre-term had some subtle impairment in the psychological tests and neuropsychological and neurobehavioural tests. So that’s a message for the physicians treating patients who are pregnant and have cancer to consider also a delivery at term and not just to take those babies out too soon.

What are the aims of the meeting?

This meeting is the first meeting regarding cancer and pregnancy which was endorsed by ESGO. ESGO is the European Society of Gynaecology Oncology and ESGO did this survey and they asked physicians, gynaecologists, medical oncologists, radiation therapists what would they do if they had seen a patient with pregnancy associated cancer. As you said, it was quite disappointing that many of these physicians would just interrupt the pregnancy because of the fear that chemotherapy could be harmful for the foetus. Even if this is true for the first trimester, it is now well known that it is not true when the patient is treated beyond the first trimester and starting from the second trimester. So this is really a need for more information among doctors and ESGO just decided, in the ESGO task force of cancer in pregnancy, to set up a number of informational meetings in which we tell doctors what is in the literature and what is appropriate as treatment for these pregnant cancer patients. And I think that this would be important because even if pregnancy and cancer is not a very frequent situation, it’s a situation that is going to increase because of the increased age at delivery and because of the increased incidence of cancer during reproductive age.

What have been the results with finding safe chemotherapy treatments?

Again there were very interesting data that were presented, some data that were generated in animal models, some data from human samples, some data for mice models. Those data clearly state that the placenta works as a filter, as an active filter. So all drugs which somehow target all the P-glycoprotein of the MRP, the ABC pumps actually, have a very high gradient between the mother and the foetus which means that just a small part of what you give to the mother gets to the foetus. And that’s very important because for some drugs the passage is really very limited, less than 5% of the drug gets to the foetus. This is very good news also in terms of counselling because if the mother knows that what she receives is not transferred to her foetus, her baby, that’s very important. This is true for anthracyclines, it’s true for taxanes; for cyclophosphamide it’s around 20-25% of passage and for other drugs the passage is more important in terms of percentage, for example for the platinum derivatives.

When will the next meeting be?

The next meeting? Well, in a couple of years and we’ll probably do it either in Germany or in Belgium or in Serbia maybe.