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Are monoclonal antibodies a safe treatment for cancer during pregnancy?

Maria Anna Sarno1, Rosanna Mancari, Hatem A Azim

  • 1Fertility & Procreation Unit in Oncology, Gynecologic Oncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.

Immunotherapy
|July 9, 2013
PubMed

Insights

Monoclonal antibodies (mAbs) offer cancer treatment, but their use during pregnancy requires caution. Bevacizumab is not recommended due to fetal risks, and Trastuzumab is linked to poor neonatal outcomes, especially after the first trimester.

Area of Science:

  • Oncology
  • Immunology
  • Maternal-Fetal Medicine

Background:

  • Monoclonal antibodies (mAbs) are vital cancer therapeutics.
  • Their safety and efficacy in pregnant patients remain largely undefined.
  • Limited data necessitates careful consideration for mAb use during gestation.

Purpose of the Study:

  • To review and analyze existing data on monoclonal antibody treatment in pregnant cancer patients.
  • To assess the safety profile of commonly used mAbs during pregnancy.
  • To provide guidance on the use of mAbs in this specific population.

Main Methods:

  • Comprehensive literature search from 2000 to January 2013.
  • Inclusion of all articles addressing the safety of mAbs during pregnancy.
  • Systematic review and analysis of reported outcomes.

Main Results:

  • Bevacizumab use is discouraged due to antiangiogenic effects and potential fetal developmental issues.
  • Trastuzumab is associated with oligohydramnios and adverse neonatal outcomes, particularly with late or repeated administration.
  • Rituximab showed no teratogenic effects but was linked to transient neonatal neutropenia without significant infections.

Conclusions:

  • The use of bevacizumab and trastuzumab during pregnancy is not recommended based on current evidence.
  • Rituximab may be used with caution, monitoring for neonatal neutropenia.
  • Limited data on other mAbs warrants their discouraged use in pregnant cancer patients.

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