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Updated: Apr 16, 2026
Comprehensive Evaluation of the Effectiveness and Safety of Placenta-Targeted Drug Delivery Using Three Complementary Methods
Published on: September 10, 2018
Targeted agents for cancer treatment during pregnancy
Matteo Lambertini1, Fedro A Peccatori2, Hatem A Azim3
1Department of Medical Oncology, UO Oncologia Medica 2, IRCCS AOU San Martino-IST, Genoa, Italy.
Abstract:
The last decade has witnessed important advances in the field of managing cancer during pregnancy. However, still limited data is available on the safety of administering targeted agents in pregnant cancer patients. Given the increasing use of targeted agents in clinical practice, it is becoming vital to properly understand how far they can be used in a pregnant patient without compromising the outcome of the fetus. Unlike chemotherapy, monoclonal antibodies are large molecules that require active transport via the placenta to reach the fetus. On the other hand, similarly to chemotherapy, small molecules like tyrosine kinase inhibitors (TKIs) can cross the placenta throughout the pregnancy period. The majority of targeted agents have worrying preclinical data discouraging their use during pregnancy. Multi-TKIs are of particular concern given their potential interference with other vital physiological functions that could be necessary in fetal development. Yet this does not mean that all targeted agents should be avoided completely during pregnancy. The current review provides a critical evaluation on all targeted agents that are currently in clinical use and provides a guide in order to help clinicians counseling their pregnant cancer patients.
Insights
Limited data exists on targeted cancer therapy safety during pregnancy. This review evaluates targeted agents, including tyrosine kinase inhibitors (TKIs), to guide clinicians in counseling pregnant patients about fetal risks.
Area of Science:
- Oncology
- Pharmacology
- Maternal-Fetal Medicine
Background:
- Advances in cancer management during pregnancy are ongoing.
- Limited data exists on the safety of targeted agents in pregnant cancer patients.
- Increasing use of targeted agents necessitates understanding fetal risks.
Purpose of the Study:
- To critically evaluate targeted agents used in pregnant cancer patients.
- To provide guidance for clinicians counseling pregnant patients on targeted therapy risks.
- To assess the placental transfer and potential fetal impact of targeted agents.
Main Methods:
- Review of clinical data on targeted agents in pregnancy.
- Analysis of placental transfer mechanisms (active transport vs. passive diffusion).
- Evaluation of preclinical data regarding fetal development and targeted agents.
Main Results:
- Monoclonal antibodies require active transport across the placenta.
- Small molecules, like tyrosine kinase inhibitors (TKIs), cross the placenta similarly to chemotherapy.
- Most targeted agents show concerning preclinical data, with multi-TKIs posing particular risks.
Conclusions:
- Not all targeted agents must be avoided during pregnancy.
- Understanding placental transfer and fetal risks is crucial for informed clinical decisions.
- This review offers a guide for managing targeted therapy in pregnant cancer patients.
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