ESGO 2013

Follow up study on the effect of chemotherapy in pregnant women

Prof Fredric Amant - University of Leuven, Belgium

http://ecancer.org/conference/381-18th-international-meeting-of-the-european-society-of-gynaecological-oncology--esgo/video/2375/follow-up-study-on-the-effect-of-chemotherapy-in-pregnant-women.php

We examined children that were born to women who received chemotherapy and/or radiotherapy during pregnancy; we are following up more than 120 children and the results actually show that these children develop normally as other children in the general population develop, so there are no differences. So these children do not have more or other congenital malformations and their cognitive and cardiac and general health is actually as in the general population. So this is one of the pivotal results that we have found.

Up to now, this finding, has it been because women receive chemotherapy and didn’t know they were pregnant?

No, it was that women, when they needed chemotherapy during pregnancy, either clinicians said, ‘We will postpone your treatment and deliver you and give the treatment afterwards,’ and that resulted also in pre-term delivery because they wanted the child to be born as soon as possible then, or it resulted in termination of pregnancy. So the fact that we did find that you can give chemotherapy during pregnancy adds to the treatment of cancer.

So how did you broach the subject with the women of giving them chemotherapy? They must have been scared of doing that.

Yes, but it started with the literature search, that we said there is some preliminary evidence but it has not been well studied. So that’s how we did explain it. Also these women really wanted their child so they said, ‘OK, we are happy to take a small risk. We’ll accept that our child may not be as normal as usual.’ They took the risk but luckily they didn’t take risks because these children actually develop normally.

And how did you construct this study? It’s not exactly your conventional clinical trial, is it?

No, in fact people have treated cancer patients who are pregnant before but the only thing is that they did not follow the children, it was not a studied subject. So what we did now is we did it systematically in an international setting; we followed the mothers, we followed the children and that’s how it goes.

And I know you’ve got a taskforce and that’s one of the big subjects here in Liverpool. What can this taskforce do?

Cancer pregnancy is an uncommon disease; we estimate that it’s one in a thousand, one in two thousand pregnancies. So in order to have good data for all these different cancer types you need a large group and that’s why we decided to set up a taskforce where we try to collaborate. We have 39 taskforce members from 18 European countries so it’s working well and we have a registry of more than 800 cases.

If you take chemotherapy, that’s one thing, what about the targeted therapies? Some of them, for instance, target angiogenesis – there could be problems there, couldn’t there?

I completely agree. We would not give angiogenesis inhibitors, also Herceptin which is used for breast cancer, it’s contra-indicated during pregnancy. Other drugs we have to be very careful also: hormone receptor agonists also can be dangerous during pregnancy. So indeed there is still a lot of work to do and with the involvement of new drugs that come out, it will be challenging to test all these in pregnancies.

And can you say that across the board any cancer can be treated or are some more suitable than others?

I think they can all be treated but the most difficult one is cervical cancer because there the pregnant organ itself is involved. But even there it is possible to treat these women and we will further explore this within our taskforce. We have now 132 cervical cancer cases during pregnancies that we are comparing to controls and the preliminary data showed that actually the outcome is the same. So even for the most difficult situation it is possible to treat these cancers during pregnancy.

So could you sum up some of the guidelines emerging from your research?

Summarising, we do feel that most cancer treatment modalities are possible during pregnancy and that, for the women, it’s important to treat as close as possible to the standard regimen and for the child it’s important not to deliver too early. We do believe that the child suffers more from prematurity than from chemotherapy during pregnancy.

Fredric, thank you very much for joining us.

My pleasure.