Pregnancy outcomes related to the treatment of sarcomas with anthracyclines and/or ifosfamide during pregnancy. (28th March 2022)

• Record Type: Journal Article
• Authors: Miller, Devon; Livingston, John A.; Park, Yeonhee; Posey, Kristi; Godbole, Sonia; Skubitz, Keith; Robinson, Steven I.; Agulnik, Mark; Davis, Lara E.; Van Tine, Brian A.; Hirbe, Angela C.; Parkes, Amanda
• Is Part Of: Cancer medicine. Volume 11:Number 18(2022)
• Page Start: 3471
• Page End: 3478
• Publication Date: 2022-03-28
• Subjects: 616.994005
• DOI: 10.1002/cam4.4707
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Background: Sarcomas are rare diagnoses but are seen with relative frequency in adolescents and young adults and thus can present in pregnancy. We sought to study the administration of anthracyclines and/or ifosfamide in pregnancy‐associated sarcomas. Patients and Methods: We conducted a multi‐institutional retrospective study, identifying sarcoma patients who received anthracyclines and/or ifosfamide during pregnancy. Chart review identified variables related to demographics, cancer diagnosis, therapies, and outcome of the patient and fetus. Wilcoxon rank‐sum test compared two independent samples. Results: We identified 13 patients at seven institutions with sarcoma who received anthracyclines and/or ifosfamide during pregnancy, including four bone sarcomas and nine soft tissue sarcomas diagnosed at a mean gestational age of 16.7 ± 5.9 weeks. Only nine patients had live births (9/13, 69.2%), with mean gestational age of 30.8 ± 3.8 weeks at delivery. The four patients with pregnancy loss all received both doxorubicin and ifosfamide, with chemotherapy initiated at 15.5 weeks as compared with 21.3 weeks for those patients with live births ( p = 0.016). Conclusion: In this multi‐institutional study of sarcoma chemotherapy regimens administered during pregnancy, we found a high rate of fetal demise that was seen only in patients receiving both doxorubicin and ifosfamide and statistically more likely with chemotherapy initiation earlier in the second trimester. While limited by a small sample size, our study represents the largest study of sarcoma patients that received anthracyclines and/or ifosfamide in pregnancy thus far reported and supports development of an international registry to study concerns raised by our study. Abstract : In this multi‐institutional study of anthracyclines and/or ifosfamide in pregnancy‐associated sarcomas, we characterized the largest group of sarcoma patients receiving such treatment in pregnancy thus far reported and identified a high rate of pregnancy complications and fetal demise. Fetal deaths were only seen in patients who received both doxorubicin and ifosfamide and were statistically more likely with chemotherapy initiation earlier in the second trimester. Maternal cancer‐related outcomes showed chemotherapy response or stable disease in the majority of patients with a median disease‐free survival of 62 months.