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Abstract：
BACKGROUND: The use of taxanes following the first trimester of pregnancy is endorsed by current clinical guidelines. However, evidence regarding their safety in terms of obstetric and neonatal outcomes is limited.
METHODS: A comprehensive literature search was performed using the MEDLINE, CENTRAL and Web of Sciences databases from their inception up to 12/16/2022. Eligibility criteria included gestational taxane use, presentation of original findings, and individual case data presented. A descriptive statistical analysis was undertaken.
RESULTS: A total of 159 patients treated with taxane-containing regimens during pregnancy were identified, resulting in 162 fetuses exposed in utero. The majority of patients had breast cancer (n = 88; 55.3%) or cervical cancer (n = 45; 28.3%). The most commonly employed taxane was paclitaxel (n = 131; 82.4%). A total of 111 (69.8%) patients were also treated with other cytotoxic drugs during pregnancy, including platinum salts (n = 70; 63.0%) and doxorubicin/cyclophosphamide (n = 20; 18.0%). While most patients received taxanes during the second trimester of pregnancy (n = 79; 70.0%), two were exposed to taxanes in the first trimester. Obstetric outcomes were reported in 105 (66.0%) cases, with the most frequent adverse events being preterm contractions or premature rupture of membranes (n = 12; 11.4%), pre-eclampsia/HELLP syndrome (n = 6; 5.7%), and oligohydramnios/anhydramnios (n = 6; 5.7%). All cases with pregnancy outcome available resulted in live births (n = 132). Overall, 72 (54.5%) neonates were delivered preterm, 40 (30.3%) were classified as small for gestational age (SGA), and 2 (1.5%) had an Apgar score of < 7 at 5 min. Perinatal complications included acute respiratory distress syndrome (n = 14; 10.6%), hyperbilirubinemia (n = 5; 3.8%), and hypoglycemia (n = 2; 1.5%). In addition, 7 (5.3%) cases of congenital malformations were reported. At a median follow-up of 16 months, offspring health status was available for 86 (65.2%), of which 13 (15.1%) had a documented complication, including delayed speech development, recurrent otitis media, and acute myeloid leukemia.
CONCLUSIONS: Taxanes appear to be safe following the first trimester of pregnancy, with obstetric and fetal outcomes being similar to those observed in the general obstetric population. Future studies should aim to determine the most effective taxane regimen and dosage for use during gestation, with a specific focus on treatment safety.
METHODS: A comprehensive literature search was performed using the MEDLINE, CENTRAL and Web of Sciences databases from their inception up to 12/16/2022. Eligibility criteria included gestational taxane use, presentation of original findings, and individual case data presented. A descriptive statistical analysis was undertaken.
RESULTS: A total of 159 patients treated with taxane-containing regimens during pregnancy were identified, resulting in 162 fetuses exposed in utero. The majority of patients had breast cancer (n = 88; 55.3%) or cervical cancer (n = 45; 28.3%). The most commonly employed taxane was paclitaxel (n = 131; 82.4%). A total of 111 (69.8%) patients were also treated with other cytotoxic drugs during pregnancy, including platinum salts (n = 70; 63.0%) and doxorubicin/cyclophosphamide (n = 20; 18.0%). While most patients received taxanes during the second trimester of pregnancy (n = 79; 70.0%), two were exposed to taxanes in the first trimester. Obstetric outcomes were reported in 105 (66.0%) cases, with the most frequent adverse events being preterm contractions or premature rupture of membranes (n = 12; 11.4%), pre-eclampsia/HELLP syndrome (n = 6; 5.7%), and oligohydramnios/anhydramnios (n = 6; 5.7%). All cases with pregnancy outcome available resulted in live births (n = 132). Overall, 72 (54.5%) neonates were delivered preterm, 40 (30.3%) were classified as small for gestational age (SGA), and 2 (1.5%) had an Apgar score of < 7 at 5 min. Perinatal complications included acute respiratory distress syndrome (n = 14; 10.6%), hyperbilirubinemia (n = 5; 3.8%), and hypoglycemia (n = 2; 1.5%). In addition, 7 (5.3%) cases of congenital malformations were reported. At a median follow-up of 16 months, offspring health status was available for 86 (65.2%), of which 13 (15.1%) had a documented complication, including delayed speech development, recurrent otitis media, and acute myeloid leukemia.
CONCLUSIONS: Taxanes appear to be safe following the first trimester of pregnancy, with obstetric and fetal outcomes being similar to those observed in the general obstetric population. Future studies should aim to determine the most effective taxane regimen and dosage for use during gestation, with a specific focus on treatment safety.
摘要：
背景：目前的临床指南认可在妊娠头三个月后使用紫杉烷类药物。然而,关于其在产科和新生儿结局方面的安全性的证据有限.
方法：使用MEDLINE进行了全面的文献检索，CENTRAL和WebofSciences数据库从成立到2022年12月16日。合格标准包括妊娠紫杉烷的使用，介绍原始发现，和提供的个案数据。进行了描述性统计分析。
结果：共有159例患者在妊娠期接受紫杉烷治疗，导致162个胎儿在子宫内暴露。大多数患者患有乳腺癌（n=88;55.3％）或宫颈癌（n=45;28.3％）。最常用的紫杉烷是紫杉醇(n=131;82.4%)。共有111例（69.8%）患者在怀孕期间也接受了其他细胞毒性药物治疗，包括铂盐(n=70;63.0%)和阿霉素/环磷酰胺(n=20;18.0%)。虽然大多数患者在妊娠中期接受紫杉烷类药物（n=79;70.0％），两个人在孕早期接触紫杉烷。产科结果报告105例（66.0％），最常见的不良事件是早产或胎膜早破（n=12;11.4％），先兆子痫/HELLP综合征（n=6;5.7％），和羊水过少/羊水过少（n=6；5.7％）。所有具有妊娠结局的病例均导致活产（n=132）。总的来说,72例（54.5%）新生儿早产，40人(30.3%)被归类为小于胎龄(SGA)，和2（1.5％）在5分钟时的Apgar评分<7。围产期并发症包括急性呼吸窘迫综合征（n=14；10.6%），高胆红素血症（n=5；3.8%），和低血糖（n=2;1.5％）。此外,报告先天性畸形7例（5.3％）。在16个月的中位随访中，后代健康状况为86(65.2%)，其中13人（15.1%）有并发症，包括延迟的言语发展，复发性中耳炎,和急性髓细胞性白血病.
结论：紫杉类药物在妊娠头三个月后似乎是安全的，产科和胎儿结局与一般产科人群相似。未来的研究应旨在确定在妊娠期间使用的最有效的紫杉烷方案和剂量。特别关注治疗安全。
方法：使用MEDLINE进行了全面的文献检索，CENTRAL和WebofSciences数据库从成立到2022年12月16日。合格标准包括妊娠紫杉烷的使用，介绍原始发现，和提供的个案数据。进行了描述性统计分析。
结果：共有159例患者在妊娠期接受紫杉烷治疗，导致162个胎儿在子宫内暴露。大多数患者患有乳腺癌（n=88;55.3％）或宫颈癌（n=45;28.3％）。最常用的紫杉烷是紫杉醇(n=131;82.4%)。共有111例（69.8%）患者在怀孕期间也接受了其他细胞毒性药物治疗，包括铂盐(n=70;63.0%)和阿霉素/环磷酰胺(n=20;18.0%)。虽然大多数患者在妊娠中期接受紫杉烷类药物（n=79;70.0％），两个人在孕早期接触紫杉烷。产科结果报告105例（66.0％），最常见的不良事件是早产或胎膜早破（n=12;11.4％），先兆子痫/HELLP综合征（n=6;5.7％），和羊水过少/羊水过少（n=6；5.7％）。所有具有妊娠结局的病例均导致活产（n=132）。总的来说,72例（54.5%）新生儿早产，40人(30.3%)被归类为小于胎龄(SGA)，和2（1.5％）在5分钟时的Apgar评分<7。围产期并发症包括急性呼吸窘迫综合征（n=14；10.6%），高胆红素血症（n=5；3.8%），和低血糖（n=2;1.5％）。此外,报告先天性畸形7例（5.3％）。在16个月的中位随访中，后代健康状况为86(65.2%)，其中13人（15.1%）有并发症，包括延迟的言语发展，复发性中耳炎,和急性髓细胞性白血病.
结论：紫杉类药物在妊娠头三个月后似乎是安全的，产科和胎儿结局与一般产科人群相似。未来的研究应旨在确定在妊娠期间使用的最有效的紫杉烷方案和剂量。特别关注治疗安全。
