Department of Medicine, Sarcoma Unit, Herault Ward, Institut Gustave Roussy, Paris Sud University, 39, rue Camille Desmoulins, 94800 Villejuif cedex, France.
Cancer Chemother Pharmacol. 2012 Feb;69(2):357-67. doi: 10.1007/s00280-011-1707-8. Epub 2011 Jul 19.
Doxorubicin and ifosfamide are highly active drugs for the treatment of high-grade sarcomas, but little is known on the optimal management of young patients who develop such malignancies during pregnancy.
We report on a single-institution series of patients (n = 9) with high-grade sarcoma diagnosed during the third trimester of pregnancy. Neoadjuvant chemotherapy combining doxorubicin (50 mg/m(2) day 1) and ifosfamide (2.5 g/m(2) days 1-2) with standard mesna rescue every 3 weeks was administered during the third trimester of pregnancy in five patients.
We observed a favourable outcome for both the mother and the offspring in all cases. Maternal and neonatal pharmacokinetic data for ifosfamide were obtained from one patient and did not evidence a transplacental transfer of this drug. The use of other active drugs (cisplatin, etoposide, dactinomycin and cyclophosphamide) in sarcoma during pregnancy is discussed on the basis of a comprehensive review of the English literature.
In view of this single-centre experience, we suggest that the treatment of high-grade sarcoma during the third trimester of pregnancy should include an adapted regimen tailored to the pharmacological specificities of the pregnant patients.
多柔比星和异环磷酰胺是治疗高级别肉瘤的高度有效药物，但对于在怀孕期间发生此类恶性肿瘤的年轻患者的最佳治疗管理方法知之甚少。
我们报告了一家机构的患者系列（n=9），这些患者在妊娠晚期被诊断出患有高级别肉瘤。在五名患者中，在妊娠晚期给予多柔比星（50mg/m²，第 1 天）和异环磷酰胺（2.5g/m²，第 1-2 天）联合新辅助化疗，每 3 周用标准美司钠解救。
在所有情况下，母亲和后代都有良好的结局。从一名患者获得了异环磷酰胺的母体和新生儿药代动力学数据，并未证明该药物存在胎盘转移。根据对英文文献的全面回顾，讨论了在妊娠期间使用其他有效药物（顺铂、依托泊苷、放线菌素 D 和环磷酰胺）治疗肉瘤的问题。
鉴于这一单一中心的经验，我们建议在妊娠晚期治疗高级别肉瘤应包括根据孕妇的药理学特点量身定制的适应方案。
