Rectal Cancer in Pregnancy: a Case Report and Review of the Literature

The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges

“…Cetuximab, panitumumab, bevacizumab, ramucirumab, and ziv-aflibercept are IgG subclass monoclonal antibodies or fusion proteins and may follow this same fetal exposure pattern [7, 37, 49-51, 53, 54]. [20,21,47,48] 587-677.19 (SN-38 5 392) D Human data: 2 cases given 5-FU in 2nd and 3rd trimester report no congenital malformations Animal data: embryotoxic, teratogenic, decreased learning, and low birth weights Oxaliplatin [15][16][17][18][19]46] 397.3 D Human data: 5 cases given 5-FU in 2nd and 3rd trimester report limited congenital malformations (1 case of hypothyroidism) Animal data: embryo-fetal toxicity and teratogenic Bevacizumab [37,49] 149,000 C Human data: no i.v. administration data Animal data: teratogenic, fetal resorptions, reduced maternal and fetal weights Ziv-Aflibercept [50] 97,000 C Human data: none Animal data: embryo-fetal toxicity and teratogenic effects Cetuximab [37,53] 152,000 C Human data: none Animal data: embryolethal and abortifacient effects Panitumumab [37,54] 147,000 C…”

“…A concern with extrapolation from these cases is the route of administration; bolus dosing is used with FAC, whereas 5-FU in CRC is given as both a bolus and continuous infusion. No congenital abnormalities, except for hypothyroidism, were found in 8 pregnant women with CRC who received 5-FU alone or in combination (with oxaliplatin or irinotecan) after the first trimester (Table 3) [15][16][17][18][19][20][21][22]. Capecitabine was given in one case of CRC during pregnancy, along with oxaliplatin, in the first trimester [13, 23].…”

“…Seven humans receiving oxaliplatin in pregnancy have been described [15-19, 23, 66]. In the five CRC patients administered 5-FU, oxaliplatin, and leucovorin (FOLFOX), treatment was given after the first trimester (initiated at 13-23 weeks' gestation) ( Table 3) [15][16][17][18][19]. In one infant, hypothyroidism was reported, but none of the remaining infants had congenital malformations reported at birth.…”

“…In one infant, hypothyroidism was reported, but none of the remaining infants had congenital malformations reported at birth. Two infants were described as small for gestational age (born at 31 and 36 weeks' gestation, respectively) [16,19]. No developmental deficits have been reported in the follow-up of these infants exposed to FOLFOX; however, height and weight for some of the children remain in a lower percentile [16,18,19].…”

“…Colorectal cancer (CRC) during pregnancy is rare, with an incidence of 1 in 13,000 pregnancies [2,10,14]. Although infrequent, CRC cases during pregnancy have been reported in the past decade [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. With thetrendindelayedchild-bearing,theraresituationofCRCduring pregnancy will likely rise in incidence.…”