Onkopedia: What's New? Systemic Tumor Treatment in Pregnancy.

Abstract

Background: An evidence-based clinical practice guideline for systemic cancer treatment in pregnant women is lacking.

Summary: The German, Austrian, and Swiss Societies for Hematology and Medical Oncology have provided an updated guideline on systemic cancer treatment in pregnancy.

Key messages: The gestational age and a multidisciplinary team are essential for treatment planning. A risk-benefit analysis is mandatory. Ultrasound and magnetic resonance imaging are preferred for diagnostic imaging during pregnancy. In the first trimester, there is an increased risk of malformations and miscarriages following systemic tumor therapy; therefore, such therapy is generally discouraged during this period. Systemic tumor therapy in the second and third trimester can result in outcomes comparable to a normal course of pregnancy and development. In cases of premature delivery, potential risks for the newborn should be considered. Systemically administered tumor therapeutics are dosed according to current standards. The use of certain medications, such as tyrosine kinase inhibitors, VEGF antibodies, anti-hormonal substances, and immune checkpoint inhibitors, is generally advised against during pregnancy. Supportive therapy agents can predominantly be used in the second and third trimesters without significant late effects for the newborn. The goal is a spontaneous delivery as for non-cancer patients; early induction of labor and Caesarian section (except for patients with cervical cancer) are discouraged. A minimum interval of 3 weeks between myelosuppressive systemic therapy and delivery is recommended to reduce potential complications. As a rule, normal early and late child development can be expected if established treatment recommendations are followed. Patient data should be entered into established registries.