Dr Ana Ferrigno Guajardo: Unanswered Questions About Taxane Chemotherapy Interventions During Pregnancy

Ana Ferrigno Guajardo, MD, a hospital resident at Yale School of Medicine, shared results from an international cohort study on the safety of taxane chemotherapy treatment in patients with breast cancer during pregnancy and explored directions for future research. The findings suggest that the use of taxane-containing chemotherapy during pregnancy does not contribute to heightened risks for obstetrical or neonatal complications; however, the results of this study left researchers with additional questions.

Transcript

Following the results of this study, are there any lingering unanswered questions regarding chemotherapy interventions during pregnancy?

I think that it's interesting that in our findings we replicated some of the most common adverse events observed in other patients treated with nontaxane chemotherapy regimens: that being preterm birth. In recent years it’s lowered to 23%, but it's still about twice as much as we would expect in the general population. So, this is still something that future studies should aim to evaluate and try to elucidate: What are the causes leading to these increased rates of preterm births?

Another is a high incidence of small-for-gestational-age neonates. Our study, as I said, is rather reassuring that the higher cumulative dose of toxins was not associated with a higher incidence of small for gestational age, suggesting no clear association between taxane use and small for gestational age, but it's still quite a high proportion of cases that have this complication. And there's multiple factors that could contribute, such as advanced maternal age at pregnancy in patients who have breast cancer. During pregnancy, there is a high inflammatory state, there are molecular changes and physiologic changes related to the malignancy, and perhaps a higher incidence of malnutrition, smoking history, and other factors that could be driving this up. And we still need studies to fully elucidate and understand what's causing small-for-gestational age neonates to create targeted interventions to address them.

And the other complication that was perhaps a bit higher than what we would expect in the general population—but not higher than in general patients with breast cancer during pregnancy not treated with taxanes—was a higher rates of pregnancy loss in the third trimester of pregnancy, which are expected to complicate only 1 out of 160 pregnancies in the general population. And in our cohort, we observed 2 cases in the 103 cases that were studied. So that is also something that should be an area of active research.