Risks of molecular targeted therapies to fertility and safety during pregnancy: a review of current knowledge and future needs

ABSTRACT

Introduction

As the population of young cancer survivors is increasing and a trend toward postponing pregnancy later in life is reported, more efforts are focused toward understanding treatment-induced sequelae, in particular, the effects of cancer and/or treatment on fertility.

Area covered

Whereas the fertility risk of cytotoxic agents for both men and women is well recognized, the impact of molecular-targeted therapy (MTT) on fertility parameters, their teratogenic potential and pregnancy outcome/management in case of an accidental exposure are not established. We update available clinical data on the impact of new MTTs on fertility in both sexes, their potential teratogenic effects and the outcome of pregnancy during accidental exposure. Agents are categorized by class and the potential relevance of their target signaling pathways to gonadal maturation.

Expert opinion

The majority of MTTs have worrying preclinical data discouraging their use during pregnancy and reinforcing the idea that they can induce impairment in gonadal function. However, it does not mean that all MTTs result in permanent infertility and that they should be completely avoided during pregnancy. The current review provides a critical evaluation on the most commonly used MTTs, offering a possible guide for clinicians.

KEYWORDS:

• Cancer survivors
• fertility
• targeted therapies
• pregnancy

Article highlights

• The population of young cancer survivors is increasing; therefore, more efforts should be addressed to understanding treatment-induced sequelae.

• A trend toward postponing pregnancy later in life is reported and many patients do not yet have children at the time of cancer diagnosis.

• Oncologists have the responsibility to inform their patients of the risk of infertility, teratogenicity and pregnancy outcome before starting antineoplastic treatment

• MTTs have recently entered into clinical practice but their impact on fertility parameters and pregnancy outcome is still unknown

• Our review updates available data on the impact of MTTs on fertility, teratogenicity, and pregnancy outcome

This box summarizes key points contained in the article.

Acknowledgments

Editorial assistance was provided by Aashni Shah (Polistudium srl, Milan, Italy). Medical writing and editorial support were provided by Editamed.

Author contributions

Authors participate in drafting the article or revising it critically for important intellectual content and give final approval of the version to be submitted and any revised version

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was funded by Fondazione Humanitas.