ECC 2015

Diagnosis while pregnant should not lead to treatment delay or pregnancy termination

Prof Frederic Amant - Katholieke Universiteit Leuven, Leuven, Belgium

If a young woman gets pregnant while she needs cancer treatment, that is an issue that you’ve been addressing in a session here and you’ve also published now some important research on this. What have you been doing in this study that you’ve just released?

We did do a case controlled study examining 129 children who were born tumerous, with cancer, and they were exposed, either yes or no, to treatment, to cancer treatment. Of these 129, 100 received chemotherapy and/or radiotherapy, 96 received chemotherapy.

Now, up until now, what has been standard practice among clinicians if a mother, an expectant mother, gets cancer and needs treatment? What’s the usual approach?

It depends a bit on the centre but overall there is still a reluctance, a hesitancy, to really treat, give chemotherapy and/or radiotherapy during pregnancy because there are some safety data but they are not optimal. I do believe that the results that we published today are actually more solid data on the safe outcome of children.

So expectant mothers could be faced with the agonising issue of do they have their cancer treatment or do they proceed with the pregnancy to do the best for their child, that’s difficult isn’t it?

It’s extremely difficult and, in particular, when you don’t know about the long-term outcome of the children. What we want to add now is that this long-term outcome is actually reassuring. So, by doing so we help them to take a decision whether or not to treat during pregnancy.

What did you find in this series of children that you’ve been studying?

We saw that actually the general health of these children is normal, that the paediatric clinical examination is normal. We did do a cognitive functioning of the children, this was normal, and we looked in particular to the heart of the children and also this was normal.

And that’s despite the fact that their mothers, during pregnancy, had treatment for cancer. What sorts of treatment and what sorts of effect might this have had on the foetus?

In particular we were concerned about the congenital malformations of an impact on the brain functions because there is an impaired blood-brain barrier so parts of these chemotherapies will reach the foetus and the brain. So we are mainly concerned on this but our results show that there is no reason, at this stage, to be concerned.

So despite whatever treatment you had, radiotherapy, chemotherapy or all sorts of things, surgery for instance, it didn’t impact the foetus at all?

No, we did not see any difference. The main clinical message is if you put ten children in a row and two were exposed to chemotherapy, nobody, you, me, my researchers, nobody will be able to identify these children.

What should doctors, then, be doing about this now that you’ve established, apparently, this fact very clearly.

I think that the results show that there is no reason to terminate the pregnancy. We can treat during the second and the third trimester of pregnancy with chemotherapy and we do prefer chemotherapy during pregnancy than inducing prematurity. Because that is another result of the study that we did see and we could prove now that prematurity is worse than chemotherapy. So that’s also a very important clinical message – we should try to continue this pregnancy as long as possible and to remain, to keep the baby as long as possible with the mother and treat during pregnancy.

So the brief, bottom line message for doctors is what?

Continue to treat, do not interrupt pregnancy. Treat during pregnancy and try to go to a mature foetus and try to treat until the foetus is mature and can be born without the effects of prematurity.