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Platinum Derivatives During Pregnancy in Cervical Cancer: A Systematic Review and Meta-Analysis

Zagouri, Flora MD, PhD; Sergentanis, Theodoros N. MD, PhD; Chrysikos, Dimosthenis MD, PhD; Bartsch, Rupert MD, PhD

doi: 10.1097/AOG.0b013e31827c5822
Review

OBJECTIVE: Cervical cancer is the most common solid carcinoma diagnosed during pregnancy; obviously, pregnancy adds complexity to treatment recommendations. We synthesized all available data and evaluated the efficacy and safety of the administration of platinum derivatives during pregnancy in cervical cancer.

DATA SOURCES: Eligible articles were identified by a search of MEDLINE and ClinicalTrials.gov databases for the period up to September 7, 2012; the algorithm comprised a predefined combination of the terms “cervical,” “cancer,” “cisplatin,” carboplatin,” and “pregnancy.”

METHODS OF STUDY SELECTION: Two investigators, working independently, searched the literature and extracted data from all studies that examined the efficacy and safety of platinum derivatives administered during pregnancy in cervical cancer. All cases in which therapeutic abortion was scheduled were excluded. Moreover, quantitative synthesis of the published articles was performed.

TABULATION, INTEGRATION, AND RESULTS: Overall, 24 studies (48 pregnancies, 48 newborns [one twin pregnancy and one miscarriage]) were eligible. In relation to cisplatin, 47 pregnancies were identified, whereas regarding carboplatin administration, only one pregnancy was retrieved. Cisplatin was administered either as monotherapy or combined with bleomycin, 5-fluorouracil, paclitaxel, vincristine, and bleomycin, whereas carboplatin was given in combination with paclitaxel. In most cases (67.4%), a completely healthy neonate was born; all children were healthy with a median follow-up of 12.5 months. The mean delivery weight of newborns was 2,213 g. Complete and partial response was achieved in 10% and 63.4% of patients with cervical cancer, respectively, whereas stabilization and progression of the disease occurred in 23.3% and 3.3% of women in the case group. In the majority of women in the case group, chemotherapy was well tolerated. The median progression-free survival was 48.5 months.

CONCLUSION: Cisplatin may play a significant role in the management of patients with cervical cancer during the second and third trimesters.

Platinum derivatives potentially may play a promising role as the optimal therapeutic strategy for patients with cervical cancer during pregnancy.

From the Comprehensive Cancer Center Vienna, Department of Medicine I/Division of Oncology, Medical School, University of Vienna, Vienna, Austria; and the 1st Propaedeutic Surgical Department, Hippocrateio Hospital, Medical School, University of Athens, Athens, Greece.

Corresponding author: Flora Zagouri, MD, PhD, Comprehensive Cancer Center Vienna, Department of Medicine I/Division of Oncology, Medical University of Vienna, Borgschkegasse 8a, A-1090, Vienna, Austria; e-mail: florazag@yahoo.gr.

Supported by a research grant from HeSMO to Flora Zagouri.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 The American College of Obstetricians and Gynecologists