Cisplatin Application in Pregnancy: First in vivo Analysis of 7 Patients

Abstract

Cervical cancer in pregnancy is an oncologic challenge. Empirical cisplatin is recommended to prevent cancer progression until fetal maturity. Seven patients with cervical cancer in the second trimester decided to delay delivery together with neoadjuvant chemotherapy. After 2–4 cycles, caesarean section and radical hysterectomy were performed above 32 weeks of gestation. Synchronous samples from maternal blood, umbilical cord blood and amniotic fluid were taken. All patients delivered healthy babies. Cisplatin concentrations in umbilical cord and amniotic fluid were 31–65 and 13–42% of the maternal blood, respectively. This is the first series on in vivo cisplatin concentration in the fetomaternal compartment.

How much platinum passes the placental barrier? Analysis of platinum applications in 21 patients with cervical cancer during pregnancy

“…[19][20][21] Despite the fact that platinum-based chemotherapy is the most frequently used systemic therapy in pregnant women with cervical cancer, only 1 small study and 1 case report have analysed maternofetal passage of cisplatinum. 22,23 It was therefore the intention of the present prospective study to extend the current literature data about the safety of chemotherapy during gestation and to reinforce our own results on in vivo measurement of platinum concentrations.…”

“…10,12,35,36 Classical indications for neoadjuvant chemotherapy in patients with cervical cancer in pregnancy are locally advanced tumors and residual cancer after conization without the possibility for further resection to avoid cervical insufficiency (potentially combined with other risk factors such as lymphvascular space involvement or grading 3). 22 It is not the aim of the present study to scrutinize indication for neoadjuvant chemotherapy and therefore it is not mentioned in the Table. In nonpregnant women diagnosed with cervical cancer the TIP (paclitaxel, ifosfamide, cisplatinum) regimen is currently considered to be the most effective neoadjuvant chemotherapy regimen. This is not, however, applicable during pregnancy because ifosfamide potentially damages fetal kidneys.…”

Platinum Derivatives During Pregnancy in Cervical Cancer

“…The administration of platinum derivatives resulted in 97.9% of women in the case group (47/48) in the birth of live neonates [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][32][33][34] and in 2.1% of women in the case group (1/48) in miscarriage. 31 In relation to cisplatin, 47 pregnancies (47 newborns) were identified ; regarding carboplatin administration, only one pregnancy (one newborn) was retrieved.…”

“…31 In relation to cisplatin, 47 pregnancies (47 newborns) were identified ; regarding carboplatin administration, only one pregnancy (one newborn) was retrieved. 17 Specifically, cisplatin was administered either as monotherapy 11,[14][15][16][18][19][20][21][22]24,25,27,[31][32][33][34] or combined with bleomycin, 26 5-fluorouracil, 33 paclitaxel, 11,12,17 vincristine, 11,13,23,[29][30][31][32] or vincristine and bleomycin 28 ; carboplatin was given in combination with paclitaxel. 17 The mean age of patients with cervical cancer at diagnosis was 32.5 years (standard deviation [SD] 4.3, median 32.5 years, range 25-42 years).…”

HPV-Infektion in der Schwangerschaft

“…SSW eine laparoskopische Lymphonodektomie erhalten. Die Kinder sind gesund und zeigten eine normale Entwicklung, auch wenn Konzentrationen von Cisplatin zwischen 31-65% im Fruchtwasser und Nabelschnurblut nachgewiesen werden konnten [17].…”