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Акушерские риски химиотерапии во время беременности
Акушерские риски химиотерапии во время беременности
Доброхотова Ю.Э., Боровкова Е.И. Акушерские риски химиотерапии во время беременности. Гинекология. 2018; 20 (6): 16–19.
DOI: 10.26442/20795696.2018.6.180064
DOI: 10.26442/20795696.2018.6.180064
DOI: 10.26442/20795696.2018.6.180064
________________________________________________
DOI: 10.26442/20795696.2018.6.180064
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Аннотация
В течение первых 4 нед гестации эмбрион не дифференцирован и воздействие химиопрепаратов происходит по принципу «все или ничего». Наиболее уязвимым для химиотерапии является период с 5 по 10-ю недели беременности, применение 1 цитостатика повышает риск развития пороков у плода до 10%, а нескольких – до 25%. Назначение терапии после 12 нед не ассоциировано с риском пороков развития, но приводит к задержке роста плода и панцитопении у новорожденных в 30%. Вероятность метастатического поражения плаценты и плода крайне низка и описана преимущественно для гематогенных опухолей. Курс лечения должен быть закончен за 3 нед до родов.
Ключевые слова: беременность, рак, химиотерапия, пороки развития, тератогенное действие, эмбриотоксичность, метастазы, задержка роста плода.
Prescription of therapy after 12 weeks is not associated with the risk of malformations. Development, but leads to delayed growth of the fetus and pancytopenia in newborns in 30%. Probability of a metostatic lesion the placenta and fetus is extremely low and is described primarily for hematogenous tumors. The course of treatment must be completed in 3 weeks. Before giving birth.
Key words: pregnancy, cancer, chemotherapy, defects developmental, teratogenic effect, embryotoxicity, metastases, delay fetal growth.
Ключевые слова: беременность, рак, химиотерапия, пороки развития, тератогенное действие, эмбриотоксичность, метастазы, задержка роста плода.
________________________________________________
Prescription of therapy after 12 weeks is not associated with the risk of malformations. Development, but leads to delayed growth of the fetus and pancytopenia in newborns in 30%. Probability of a metostatic lesion the placenta and fetus is extremely low and is described primarily for hematogenous tumors. The course of treatment must be completed in 3 weeks. Before giving birth.
Key words: pregnancy, cancer, chemotherapy, defects developmental, teratogenic effect, embryotoxicity, metastases, delay fetal growth.
Полный текст
Список литературы
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13. Syme MR, Paxton JW, Keelan JA. Drug transfer and metabolism by the human placenta. Clin Pharmacokinet 2004; 43 (8): 487–514.
14. Pacifici GM, Nottoli R. Placenta transferof drugs administered to the mother. Clin Pharmacokinet 1995; 28 (3): 235–69.
15. Nekhayeva IA, Nanovskaya TN, Hankins GD, Ahmed MS. Role of human placental efflux transporter P-glycoprotein in the transfer of buprenorphine, levo-alpha-acetylmethadol, and paclitaxel. Am J Perinatol 2006; 23 (7): 423–30.
16. D'Incalci M, Sessa C, Colombo N et al. Transplacental passage of cyclophosphamide. Cancer Treat Rep 1982; 66 (8): 1681–2.
17. Van Hasselt JG, van Calsteren K, Heyns L, Han S. Optimizing anticancer drug treatment in pregnancy cancer patients: pharmacokinetic analysis of gestation-indused changes for doxorubicin, epirubicin, docetaxel and paclitaxel. Ann Oncol 2014; 25 (10): 2059–65.
18. Eltorky M, Khare VK, Osborne P, Shanklin DR. Placental metastasis from maternal carcinoma. A report of three cases. J Reprod Med 1995; 40 (5): 399.
19. Baergen RN, Johnson D, Moore T, Benirschke K. Maternal melanoma metastatic to the placenta: a case report and review of the literature. Arch Pathol Lab Med 1997; 121 (5): 508.
20. Wang T, Hamann W, Hartge R. Structural aspects of a placenta from a case of maternal acute lymphatic leukaemia. Placenta 1983; 4 (2): 185.
21. Russell P, Laverty CR. Malignant melanoma metastases in the placenta: a case report. Pathology 1977; 9 (3): 251.
22. Sokol RJ, Hutchison P, Cowan D, Reed GB. Amelanotic melanoma metastatic to the placenta. Am J Obstet Gynecol 1976; 124 (4): 431.
23. Potter JF, Schoeneman M. Metastasis of maternal cancer to the placenta and fetus. Cancer 1970; 25 (2): 380.
24. Tsukamoto N, Kashimura Y, Sano M et al. Choriocarcinoma occurring within the normal placenta with breast metastasis. Gynecol Oncol 1981; 11 (3): 348.
25. Choriocarcinoma of the placenta. By the OSMA Committee on Maternal Health. Ohio State Med J 1975; 71 (3): 144.
26. Alexander A, Samlowski WE, Grossman D et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol 2003; 21 (11): 2179.
27. Altman JF, Lowe L, Redman B et al. Placental metastasis of maternal melanoma. J Am Acad Dermatol 2003; 49 (6): 1150.
28. Pavlidis N. Lung cancer during pregnancy: an emerging issue. Lung Cancer 2008; 59 (3): 279.
29. Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. Ultrasound Obstet Gynecol 2009; 33 (2): 235.
30. Sotelo-Avila C, Graham M, Hanby DE, Rudolph AJ. Nevus cell aggregates in the placenta. A histochemical and electron microscopic study. Am J Clin Pathol 1988; 89 (3): 395.
2. Ring AE, Smith IE, Ellis PA. Breast cancer and pregnancy. Ann Oncol 2005; 16 (12): 18555–60.
3. Beadle BM, Woodward WA, Middleton LP, Tereffe W. The impact of pregnancy on breast cancer outcomes in women before 35 years. Cancer 2009; 115 (6): 1174–84.
4. Amant F, Deckers S, Van Calsteren K, Loibl S. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer 2010; 46 (18): 3158–68.
5. Mir O, Berveiller P. Increased evidence for use of chemotherapy in pregnancy. Lancet Oncol 2012; 13 (9): 852–4.
6. Loibl S, Han SN, von Minckwitz G et al. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 2012; 13 (9): 887–96.
7. Amant F, Halaska MJ, Fumagalli M, Dahl Steffensen K. Gynecologic cancers in pregnancy: guideline of a Second International Consensus Meeting. Int J Gynecol Cancer 2014; 24 (3): 394–03.
8. Mir O, Berveiller P, Pons G. Trastuzumsb – mechanism of action and use. N Engl J Med 2007: 357 (16): 1664–5.
9. Loibl S, Sdhmidt A, Gentilini O, Kaufman B. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA Oncol 2015; 1 (8): 1145–53.
10. Anderson GD. Pregnancy-indused changes in pharmacokinetics: a mechanistic-baced approach. Clin Pharmacokinet 2005; 44 (10): 989–1008.
11. Scripture CD, Sparreboom A, Figg WD. Modulation of cytochrome P450 activity: implications for cancer therapy. Lancet Oncol 2005; 6 (10): 780–9.
12. Krauer B, Dayer P, Anner R. Changes in serum albumin and alpha 1-acid glycoprotein concentrations during pregnancy: an analysis of fetal-maternal pairs. Br J Obstet Gynaecol 1984; 91 (9): 875–81.
13. Syme MR, Paxton JW, Keelan JA. Drug transfer and metabolism by the human placenta. Clin Pharmacokinet 2004; 43 (8): 487–514.
14. Pacifici GM, Nottoli R. Placenta transferof drugs administered to the mother. Clin Pharmacokinet 1995; 28 (3): 235–69.
15. Nekhayeva IA, Nanovskaya TN, Hankins GD, Ahmed MS. Role of human placental efflux transporter P-glycoprotein in the transfer of buprenorphine, levo-alpha-acetylmethadol, and paclitaxel. Am J Perinatol 2006; 23 (7): 423–30.
16. D'Incalci M, Sessa C, Colombo N et al. Transplacental passage of cyclophosphamide. Cancer Treat Rep 1982; 66 (8): 1681–2.
17. Van Hasselt JG, van Calsteren K, Heyns L, Han S. Optimizing anticancer drug treatment in pregnancy cancer patients: pharmacokinetic analysis of gestation-indused changes for doxorubicin, epirubicin, docetaxel and paclitaxel. Ann Oncol 2014; 25 (10): 2059–65.
18. Eltorky M, Khare VK, Osborne P, Shanklin DR. Placental metastasis from maternal carcinoma. A report of three cases. J Reprod Med 1995; 40 (5): 399.
19. Baergen RN, Johnson D, Moore T, Benirschke K. Maternal melanoma metastatic to the placenta: a case report and review of the literature. Arch Pathol Lab Med 1997; 121 (5): 508.
20. Wang T, Hamann W, Hartge R. Structural aspects of a placenta from a case of maternal acute lymphatic leukaemia. Placenta 1983; 4 (2): 185.
21. Russell P, Laverty CR. Malignant melanoma metastases in the placenta: a case report. Pathology 1977; 9 (3): 251.
22. Sokol RJ, Hutchison P, Cowan D, Reed GB. Amelanotic melanoma metastatic to the placenta. Am J Obstet Gynecol 1976; 124 (4): 431.
23. Potter JF, Schoeneman M. Metastasis of maternal cancer to the placenta and fetus. Cancer 1970; 25 (2): 380.
24. Tsukamoto N, Kashimura Y, Sano M et al. Choriocarcinoma occurring within the normal placenta with breast metastasis. Gynecol Oncol 1981; 11 (3): 348.
25. Choriocarcinoma of the placenta. By the OSMA Committee on Maternal Health. Ohio State Med J 1975; 71 (3): 144.
26. Alexander A, Samlowski WE, Grossman D et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol 2003; 21 (11): 2179.
27. Altman JF, Lowe L, Redman B et al. Placental metastasis of maternal melanoma. J Am Acad Dermatol 2003; 49 (6): 1150.
28. Pavlidis N. Lung cancer during pregnancy: an emerging issue. Lung Cancer 2008; 59 (3): 279.
29. Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. Ultrasound Obstet Gynecol 2009; 33 (2): 235.
30. Sotelo-Avila C, Graham M, Hanby DE, Rudolph AJ. Nevus cell aggregates in the placenta. A histochemical and electron microscopic study. Am J Clin Pathol 1988; 89 (3): 395.
2. Ring AE, Smith IE, Ellis PA. Breast cancer and pregnancy. Ann Oncol 2005; 16 (12): 18555–60.
3. Beadle BM, Woodward WA, Middleton LP, Tereffe W. The impact of pregnancy on breast cancer outcomes in women before 35 years. Cancer 2009; 115 (6): 1174–84.
4. Amant F, Deckers S, Van Calsteren K, Loibl S. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer 2010; 46 (18): 3158–68.
5. Mir O, Berveiller P. Increased evidence for use of chemotherapy in pregnancy. Lancet Oncol 2012; 13 (9): 852–4.
6. Loibl S, Han SN, von Minckwitz G et al. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 2012; 13 (9): 887–96.
7. Amant F, Halaska MJ, Fumagalli M, Dahl Steffensen K. Gynecologic cancers in pregnancy: guideline of a Second International Consensus Meeting. Int J Gynecol Cancer 2014; 24 (3): 394–03.
8. Mir O, Berveiller P, Pons G. Trastuzumsb – mechanism of action and use. N Engl J Med 2007: 357 (16): 1664–5.
9. Loibl S, Sdhmidt A, Gentilini O, Kaufman B. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA Oncol 2015; 1 (8): 1145–53.
10. Anderson GD. Pregnancy-indused changes in pharmacokinetics: a mechanistic-baced approach. Clin Pharmacokinet 2005; 44 (10): 989–1008.
11. Scripture CD, Sparreboom A, Figg WD. Modulation of cytochrome P450 activity: implications for cancer therapy. Lancet Oncol 2005; 6 (10): 780–9.
12. Krauer B, Dayer P, Anner R. Changes in serum albumin and alpha 1-acid glycoprotein concentrations during pregnancy: an analysis of fetal-maternal pairs. Br J Obstet Gynaecol 1984; 91 (9): 875–81.
13. Syme MR, Paxton JW, Keelan JA. Drug transfer and metabolism by the human placenta. Clin Pharmacokinet 2004; 43 (8): 487–514.
14. Pacifici GM, Nottoli R. Placenta transferof drugs administered to the mother. Clin Pharmacokinet 1995; 28 (3): 235–69.
15. Nekhayeva IA, Nanovskaya TN, Hankins GD, Ahmed MS. Role of human placental efflux transporter P-glycoprotein in the transfer of buprenorphine, levo-alpha-acetylmethadol, and paclitaxel. Am J Perinatol 2006; 23 (7): 423–30.
16. D'Incalci M, Sessa C, Colombo N et al. Transplacental passage of cyclophosphamide. Cancer Treat Rep 1982; 66 (8): 1681–2.
17. Van Hasselt JG, van Calsteren K, Heyns L, Han S. Optimizing anticancer drug treatment in pregnancy cancer patients: pharmacokinetic analysis of gestation-indused changes for doxorubicin, epirubicin, docetaxel and paclitaxel. Ann Oncol 2014; 25 (10): 2059–65.
18. Eltorky M, Khare VK, Osborne P, Shanklin DR. Placental metastasis from maternal carcinoma. A report of three cases. J Reprod Med 1995; 40 (5): 399.
19. Baergen RN, Johnson D, Moore T, Benirschke K. Maternal melanoma metastatic to the placenta: a case report and review of the literature. Arch Pathol Lab Med 1997; 121 (5): 508.
20. Wang T, Hamann W, Hartge R. Structural aspects of a placenta from a case of maternal acute lymphatic leukaemia. Placenta 1983; 4 (2): 185.
21. Russell P, Laverty CR. Malignant melanoma metastases in the placenta: a case report. Pathology 1977; 9 (3): 251.
22. Sokol RJ, Hutchison P, Cowan D, Reed GB. Amelanotic melanoma metastatic to the placenta. Am J Obstet Gynecol 1976; 124 (4): 431.
23. Potter JF, Schoeneman M. Metastasis of maternal cancer to the placenta and fetus. Cancer 1970; 25 (2): 380.
24. Tsukamoto N, Kashimura Y, Sano M et al. Choriocarcinoma occurring within the normal placenta with breast metastasis. Gynecol Oncol 1981; 11 (3): 348.
25. Choriocarcinoma of the placenta. By the OSMA Committee on Maternal Health. Ohio State Med J 1975; 71 (3): 144.
26. Alexander A, Samlowski WE, Grossman D et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol 2003; 21 (11): 2179.
27. Altman JF, Lowe L, Redman B et al. Placental metastasis of maternal melanoma. J Am Acad Dermatol 2003; 49 (6): 1150.
28. Pavlidis N. Lung cancer during pregnancy: an emerging issue. Lung Cancer 2008; 59 (3): 279.
29. Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. Ultrasound Obstet Gynecol 2009; 33 (2): 235.
30. Sotelo-Avila C, Graham M, Hanby DE, Rudolph AJ. Nevus cell aggregates in the placenta. A histochemical and electron microscopic study. Am J Clin Pathol 1988; 89 (3): 395.
________________________________________________
2. Ring AE, Smith IE, Ellis PA. Breast cancer and pregnancy. Ann Oncol 2005; 16 (12): 18555–60.
3. Beadle BM, Woodward WA, Middleton LP, Tereffe W. The impact of pregnancy on breast cancer outcomes in women before 35 years. Cancer 2009; 115 (6): 1174–84.
4. Amant F, Deckers S, Van Calsteren K, Loibl S. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer 2010; 46 (18): 3158–68.
5. Mir O, Berveiller P. Increased evidence for use of chemotherapy in pregnancy. Lancet Oncol 2012; 13 (9): 852–4.
6. Loibl S, Han SN, von Minckwitz G et al. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 2012; 13 (9): 887–96.
7. Amant F, Halaska MJ, Fumagalli M, Dahl Steffensen K. Gynecologic cancers in pregnancy: guideline of a Second International Consensus Meeting. Int J Gynecol Cancer 2014; 24 (3): 394–03.
8. Mir O, Berveiller P, Pons G. Trastuzumsb – mechanism of action and use. N Engl J Med 2007: 357 (16): 1664–5.
9. Loibl S, Sdhmidt A, Gentilini O, Kaufman B. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA Oncol 2015; 1 (8): 1145–53.
10. Anderson GD. Pregnancy-indused changes in pharmacokinetics: a mechanistic-baced approach. Clin Pharmacokinet 2005; 44 (10): 989–1008.
11. Scripture CD, Sparreboom A, Figg WD. Modulation of cytochrome P450 activity: implications for cancer therapy. Lancet Oncol 2005; 6 (10): 780–9.
12. Krauer B, Dayer P, Anner R. Changes in serum albumin and alpha 1-acid glycoprotein concentrations during pregnancy: an analysis of fetal-maternal pairs. Br J Obstet Gynaecol 1984; 91 (9): 875–81.
13. Syme MR, Paxton JW, Keelan JA. Drug transfer and metabolism by the human placenta. Clin Pharmacokinet 2004; 43 (8): 487–514.
14. Pacifici GM, Nottoli R. Placenta transferof drugs administered to the mother. Clin Pharmacokinet 1995; 28 (3): 235–69.
15. Nekhayeva IA, Nanovskaya TN, Hankins GD, Ahmed MS. Role of human placental efflux transporter P-glycoprotein in the transfer of buprenorphine, levo-alpha-acetylmethadol, and paclitaxel. Am J Perinatol 2006; 23 (7): 423–30.
16. D'Incalci M, Sessa C, Colombo N et al. Transplacental passage of cyclophosphamide. Cancer Treat Rep 1982; 66 (8): 1681–2.
17. Van Hasselt JG, van Calsteren K, Heyns L, Han S. Optimizing anticancer drug treatment in pregnancy cancer patients: pharmacokinetic analysis of gestation-indused changes for doxorubicin, epirubicin, docetaxel and paclitaxel. Ann Oncol 2014; 25 (10): 2059–65.
18. Eltorky M, Khare VK, Osborne P, Shanklin DR. Placental metastasis from maternal carcinoma. A report of three cases. J Reprod Med 1995; 40 (5): 399.
19. Baergen RN, Johnson D, Moore T, Benirschke K. Maternal melanoma metastatic to the placenta: a case report and review of the literature. Arch Pathol Lab Med 1997; 121 (5): 508.
20. Wang T, Hamann W, Hartge R. Structural aspects of a placenta from a case of maternal acute lymphatic leukaemia. Placenta 1983; 4 (2): 185.
21. Russell P, Laverty CR. Malignant melanoma metastases in the placenta: a case report. Pathology 1977; 9 (3): 251.
22. Sokol RJ, Hutchison P, Cowan D, Reed GB. Amelanotic melanoma metastatic to the placenta. Am J Obstet Gynecol 1976; 124 (4): 431.
23. Potter JF, Schoeneman M. Metastasis of maternal cancer to the placenta and fetus. Cancer 1970; 25 (2): 380.
24. Tsukamoto N, Kashimura Y, Sano M et al. Choriocarcinoma occurring within the normal placenta with breast metastasis. Gynecol Oncol 1981; 11 (3): 348.
25. Choriocarcinoma of the placenta. By the OSMA Committee on Maternal Health. Ohio State Med J 1975; 71 (3): 144.
26. Alexander A, Samlowski WE, Grossman D et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol 2003; 21 (11): 2179.
27. Altman JF, Lowe L, Redman B et al. Placental metastasis of maternal melanoma. J Am Acad Dermatol 2003; 49 (6): 1150.
28. Pavlidis N. Lung cancer during pregnancy: an emerging issue. Lung Cancer 2008; 59 (3): 279.
29. Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. Ultrasound Obstet Gynecol 2009; 33 (2): 235.
30. Sotelo-Avila C, Graham M, Hanby DE, Rudolph AJ. Nevus cell aggregates in the placenta. A histochemical and electron microscopic study. Am J Clin Pathol 1988; 89 (3): 395.
Авторы
Ю.Э.Доброхотова, Е.И.Боровкова*
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*katyanikitina@mail.ru
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*katyanikitina@mail.ru
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*katyanikitina@mail.ru
________________________________________________
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*katyanikitina@mail.ru
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