Safe use of chemotherapy in pregnancy reported

Doctors in Germany have reported that a patient with cancer who began a course of chemotherapy during pregnancy was still able to give birth to a healthy child.

Dr. Holger Stepan, a consultant at the Department of Gynaecology and Obstetrics at Leipzig University Clinic, told Reuters Health on Monday that the 24-year-old patient was diagnosed with Hodgkin’s disease during her 28th week of pregnancy.”At that point we had to weigh the risk of delivering the baby immediately, with all the risks associated with a premature delivery…against the risks of starting a course of chemotherapy during pregnancy, but with the advantage for the child of being able to prolong the pregnancy,” said Dr. Stepan.The patient was given a low dose of chemotherapy in the 32nd week of gestation with adriamycin, bleomycin, vincristine and dacarbazine. “We chose to give half the dosage to reduce the risk of neutropenia and thrombocytopenia,” Dr. Stepan said. “The patient responded well to the therapy.”In the 34th week, the baby was delivered by Caesarean section and was found to be healthy. The patient was then given a course of high-dose chemotherapy and subsequent radiotherapy. The mother has since fully recovered with no apparent residual disease.Dr. Stepan said the case added to the growing body of evidence that patients and doctors often overestimate the risks of in-utero exposure to chemotherapy. He said some types of chemotherapy can be given in the second or third trimester of a pregnancy without a risk of fetal malformations. “Chemotherapy given in the first trimester of pregnancy can lead to fetal malformations,” he added.Hodgkin’s disease is the most frequent form of cancer among pregnant women after breast cancer, cervical cancer and melanomas. As the disease appears most frequently in older patients, Dr. Stepan said, the incidence in pregnant women would likely increase because of the tendency for women to have children later in life.(Source: Jane Burgermeister: Reuters Health: July 1, 2003: Oncolink)