Use of anticancer agents in gynecological oncology during pregnancy: a systematic review of maternal pharmacokinetics and transplacental transfer

ABSTRACT

Introduction: Cancer affects one in a thousand pregnant women and gynecological cancers are one of the most frequent malignancies. Chemotherapy remains the cornerstone treatment for gynecological cancer. Although all chemotherapeutic agents can cross the placental barrier, the extent of placental transfer varies considerably. Furthermore, the significant physiological variations observed in pregnant women may have an impact on pharmacokinetic parameters. Given the complexity of predicting placental transfer, in vivo and ex vivo studies are essential in this context. In view of the paucity of data on chemotherapy during pregnancy, the objective of the present study was to summarize all the available data on the transplacental transfer of anticancer drugs used to treat gynecological cancers.

Areas covered: In order to evaluate the in vivo and ex vivo transplacental transfer of the anticancer drugs most frequently used in gynecological malignancies, we carried out a comprehensive review of the literature published from 1967 to 2015. Lastly, we summarized recent clinical guidelines on the treatment of gynecological cancers in pregnant patients.

Expert opinion: The preclinical and scarce clinical data must now be extrapolated to define the maternofetal toxicity/efficacy profile and thus guide the physicians to choose anticancer drugs more efficiently in this complex situation.

KEYWORDS:

• Anticancer agent
• cancer
• placenta
• pregnancy
• transplacental transfer

Article highlights

• Gynecological cancers are one of the most frequent malignancies occurring during pregnancy.

• All anticancer agents can (in theory) cross the placental barrier, but the extent of placental transfer varies considerably from one compound to another. Furthermore, the significant physiological variations observed in pregnant women may have an impact on pharmacokinetic parameters (relative to nonpregnant women).

• Preclinical studies (such as animal studies and ex vivo placental perfusion) and human clinical studies are mandatory in order to use these drugs appropriately during pregnancy.

• To date, there is preclinical and clinical evidence of the transplacental transfer of various anticancer drugs frequently used to treat gynecological cancers.

• Taxanes seem to exhibit the most favorable preclinical and pharmacological profile for use during pregnancy.

• Further studies are nevertheless warranted in order to collect additional preclinical and clinical data to better handle these anticancer drugs during pregnancy.

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Declaration of interest

The authors were supported by O Mir is has served as a consultant/speaker for AstraZeneca, Bayer, GSK, Novartis, Pfizer, Roche and Servier. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.