Read a summary on the various aspects of our research project 'Cancer during Pregnancy'
How it started...
It is estimated that annually in Europe 2,500 - 5,000 women are diagnosed with cancer during pregnancy. In 2004, we treated a pregnant cancer patient with chemotherapy upon her explicit request. Doctors advised her to terminate the pregnancy, but eventually this young woman convinced the physicians otherwise. Today, mother and child are doing well. Our quest for information on the best option to treat cancer during pregnancy taught us how limited the scientific evidence was. Therefore, we started a research project in 2005 aiming to eliminate the information void through preclinical and clinical study and be able to better inform physicians and patients about the possibilities to treat pregnant women with cancer.
To get a better understanding of the issue, we gather data of an international registration study which we set up within the framework of a European workgroup (see also 'European Task Force') of the European Society of Gynaecological Oncology (professionals can register for this study via: 'www.cancerinpregnancy.org'). This dataset gives us information on the cancer diagnosis and treatment, the pregnancy and the outcome for mother and child. Data on 503 cases show that breast cancer (42%) and hematological cancer (18%) are the most frequent cancers occuring during pregnancy. It is a reassuring observation that there is not an increase in birthdefects in children whose mothers received chemotherapy during the second and third trimester of pregnancy.
One of the most important knowledge voids we eliminated through the research project, is determining the fraction of chemotherapy which reaches the fetus. This research was done on animals since these experiments aren't ethically acceptable to conduct in humans. Nevertheless, the results of this animal model (babboons) translates well to the human setting. It is determined that the placenta functions as a filter and protects the fetus against the toxic influence of chemotherapy.
The long term effect on children exposed to chemotherapy in the whomb, is being carefully studied in an international collaboration. We conduct a questionnaire on the general development and level of education. Furthermore, neurological tests are done at set times: on newborns (standardized clinical neurological tests), at the age of 18 months (Bayley score); 6 years (IQ-test, audiometry, neuropsychologic testing for concentration and attention); 9 years (same as 6 years old + Evoked Related Potentials test) and furthermore every three years. With every evaluation moment, an exam of the heart is conducted as well. We currently see 121 children for follow-up and the first interim analysis on 70 children who are 18 months or older, show reassuring results.
Our data was presented on the European Multidisciplinary Cancer Conference in September 2011 in Stockholm. Read the press release here.
Summarized, the study so far resulted in new insights, improvement of the treatment of pregnant women with cancer, and a decrease in terminations of pregnancies.