A Narrative Review of Evidence, Safety, and Clinical Considerations in Taxane Chemotherapy for Pregnancy-Associated...

The medical condition of pregnancy-associated breast cancer (PABC) requires oncologists to determine the best way to protect both the mother and the fetus during cancer treatment. The safety profile of taxanes, including paclitaxel and docetaxel, in the second and third trimesters of pregnancy remains unclear despite well-established anthracycline-based regimens (e.g., doxorubicin). High-risk breast cancer subtypes such as triple negative breast cancer (TNBC) and human epidermal growth factor receptor (HER2)-positive disease require taxane chemotherapy as standard treatment in nonpregnant patients. Objective: This paper aims to gather available data about the safety, timing and fetal outcomes related to taxane chemotherapy during PABC, focusing on pharmacological and clinical guidance. Methods: A targeted literature review of PubMed and Scopus databases was performed to identify case series, cohort studies, and clinical guidelines addressing taxane use during pregnancy. This was not conducted as a formal systematic review or meta-analysis, but as a comprehensive narrative synthesis of available data. Results: The pharmacological properties of paclitaxel and docetaxel limit their placental transfer. Paclitaxel has not been associated with increased congenital anomalies; however, the long-term developmental data remain limited. Similarly, docetaxel administration shows no increase in major malformations. The most common approach used in PABC is to administer anthracyclines first and taxanes after 16-18 weeks' gestation. The adverse effects experienced by pregnant patients match those experienced by nonpregnant patients. Conclusions: Taxanes can be used with caution after the first trimester in patients with PABC, especially in high-risk cases following anthracycline treatment. The absence of randomized trials combined with limited developmental data highlight the need for more standardized treatment approaches, aligning with current guideline recommendations.