Paclitaxel and cisplatin chemotherapy for ovarian cancer during pregnancy: case report and review of the literature

The safety of chemotherapy during pregnancy is debatable. We present a case of advanced ovarian cancer, diagnosed at week 28 of gestational age, treated with 2 cycles of paclitaxel/cisplatin (TC) chemotherapy during pregnancy, with no serious toxicity. At week 34, the patient underwent a caesarean section and delivered a healthy girl. Four additional cycles of TC were administered. Three months after completing chemotherapy, the patient developed abdominal progression and subsequently a huge metastatic cystic mass in the brain. Despite subsequent therapies, the patient died of progressive disease 35 months after the diagnosis. The infant had normal growth and development by 73 months of her age. This is another reported case of ovarian cancer diagnosed during the second trimester of the pregnancy treated with TC chemotherapy without apparent teratogenic effect.     

Preservation of pregnancy in a patient with a stage IIIB ovarian epithelial carcinoma diagnosed at 22 weeks of gestation and treated with initial chemotherapy: case report and literature review

BACKGROUND: To report a case of successful management of a FIGO stage III endometrioid carcinoma of the ovary diagnosed during pregnancy at 22 weeks of gestation and treated with initial chemotherapy while preserving the pregnancy. CASE: The patient underwent a planned cesarean section at 34 weeks after two courses of carboplatin. She delivered a healthy baby. At the same time, a radical hysterectomy, omentectomy, pelvic and paraaortic lymphadenectomies and peritonectomies were carried out. The surgical resection was complete (no macroscopic residual disease). During histologic examination, traces of persistent disease were found. The patient underwent seven postoperative courses of chemotherapy (carboplatin + paclitaxel regimen) after radical surgery. After 18 months of follow-up posttreatment, the patient remains in complete remission and the child's development is normal. CONCLUSION: Chemotherapy during pregnancy with preservation of the fetus could be considered and should be discussed in case of epithelial ovarian cancer (EOC) diagnosed during the second trimester of the pregnancy.     

Preservation of pregnancy in a patient with advanced ovarian cancer at 20 weeks of gestation: case report and literature review

To report a case of FIGO stage III papillary serous carcinoma of ovary, diagnosed during pregnancy at 20 weeks of gestation and treated with unilateral salpingo-oophorectomy and surgical staging, then initial combination chemotherapy while preserving the pregnancy. The patient underwent cesarean section at 35 weeks after four courses of taxol plus carboplatin. She delivered a healthy baby. After that total hysterectomy, omentectomy, pelvic and para-aortic lymphadenectomies were carried out. The surgical resection was complete and no macroscopic residual diseases were seen. During histologic examination, traces of resistant disease were found. The patient underwent three postoperative courses of chemotherapy (carboplatin plus paclitaxel regimen). After 6 months follow-up, the patient remained in complete remission and the child's development was normal. Combination chemotherapy during pregnancy with preservation of the fetus could be considered, and should be discussed with caution in case of epithelial ovarian cancer diagnosed during the second trimester of the pregnancy.     

Recurrent metastatic fallopian tube carcinoma in pregnancy

BACKGROUND: Fallopian tube cancer is the rarest of all gynecologic cancers. An extensive literature search on Medline reveals no previous case reports of fallopian tube carcinoma in association with a term pregnancy. CASE: A woman with surgical stage IIB fallopian tube carcinoma was treated with limited staging laparotomy, as per the patient's fertility wishes, followed by adjuvant cis-platinum and paclitaxel (Taxol). One year following chemotherapy, she conceived. She was noted to have an asymptomatic intraabdominal recurrence at 16 weeks. The patient completed 37 weeks of pregnancy without further therapy according to her wishes. She subsequently underwent a cesarean section with optimal tumor reduction surgery. Carboplatin and paclitaxel were reinstituted, achieving partial response. She is presently alive with stable disease status 6 months after completing her salvage chemotherapy. CONCLUSION: This is the first case report of recurrent fallopian tube cancer in pregnancy.     

Management of an advanced ovarian cancer at 15 weeks of gestation: case report and literature review

BACKGROUND: To report a case of advanced ovarian carcinoma diagnosed during gestation, which was managed with conservative surgery and chemotherapy until delivery. CASE: The patient underwent bilateral salpingo-oophorectomy, omentectomy, and appendectomy at 15 weeks of gestation. Six courses of chemotherapy with cisplatin were administered. Cesarean section followed by total hysterectomy were performed at 36 weeks of gestation. The male infant was 3000 g, Apgar score 9/9. Twenty-four months after delivery, the patient experienced pelvic recurrence and underwent surgery and six cycles of carboplatin and paclitaxel. The patient is alive with no evidence of disease. After 42 months of follow-up, the baby boy showed no evidence of sequelae. CONCLUSION: Medical and surgical management of ovarian cancer during pregnancy can be an option, although the risks and benefits have to be discussed with caution.     

Long-term follow-up after neoadjuvant chemotherapy for high-risk cervical cancer during pregnancy

BACKGROUND: We report on a patient with a high-risk cervical cancer during pregnancy treated with neoadjuvant chemotherapy (NACT) followed by radical surgery. CASE: A 38-year-old woman was diagnosed with FIGO stage IIA cervical cancer at 19 weeks' gestation. She received four cycles of cisplatin (50 mg/m2) and vincristine (1 mg/m2) at 3-week intervals starting at 23 weeks' gestation. A cesarean section with radical hysterectomy and pelvic lymphadenectomy was performed at 33 weeks, delivering a 1920 g male newborn. Histology showed a poorly differentiated squamous cell carcinoma with lymph vascular invasion and pelvic lymph node metastases. The patient received three further cycles of chemotherapy. Both mother and child are healthy at 80 months after the primary diagnosis. CONCLUSION: NACT followed by radical surgery may be effective in selected patients with invasive cervical cancer during pregnancy.     

Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma

Background Diagnosis of malignant ovarian tumours during pregnancy is uncommon. This report presents a case of a pregnant woman with ovarian dysgerminoma. Case report At 24 weeks gestation, a 33-year-old patient was diagnosed with unilateral ovarian dysgerminoma. Because the tumour was considered to be at an advanced stage (FIGO III), she received three cycles of paclitaxel and carboplatin. At 36 weeks gestation, she underwent a caesarean section, abdominal hysterectomy, bilateral salpingovarectomy, omentectomy, and lymphadenectomy. After surgery, she received three additional cycles of chemotherapy in an adjuvant setting. At birth, the infant was responsive to stimuli, and 20 months after delivery, the infant exhibited normal development. Conclusion This case report illustrates the difficulties arising from diagnosis of malignancy during pregnancy. Although combined treatment with paclitaxel and carboplatin is not considered a first-line therapy for ovarian dysgerminoma, in this case report it elicited an excellent response, and there were no adverse effects on the foetus.     

Gastric carcinoma diagnosed at the third trimester: a case report

Gastric carcinoma associated with pregnancy appears to be an extremely rare entity. It is usually diagnosed at advanced stages of the disease and presents a grave prognosis. Since the fatal outcome shows a rapid course within months of diagnosis, prompt gastroduodenal endoscopic examination following early clinical suspicion is mandatory. A case of 29 year–old pregnant woman with 31 weeks of gestation is herein presented. The women was diagnosed as gastric adenocarcinoma while being investigated for intractable nausea, vomiting, and a concomitant epigastric mass. She underwent radical gastric resection and received six cycles of adjuvant chemotherapy following vaginal delivery of a healthy 1950 g fetus. The patient was dead 20 weeks after the surgery due to pulmonary and hepatic metastasis.     

Pregnancy after limb-sparing hemipelvectomy for Ewing's sarcoma. A case report and review of the literature

Ewing's sarcoma of the bone is a malignant bone tumor occurring mostly in adolescence and was considered to have poor prognosis. With recent advances in multi-agent combined chemotherapy, prognosis has improved, and more patients with primary lesions in the pelvis opt for limb-saving surgeries. In the present case, Ewing's sarcoma in the left pelvis was diagnosed at the age of 11 and the patient underwent multi-agent chemotherapy combined with limb-sparing hemipelvectomy. She became pregnant at the age of 22. After an uneventful pregnancy, she delivered a healthy child at 37 weeks of gestation by cesarean section because of pelvic distortion. This is the first reported case of pregnancy and delivery after limb-sparing hemipelvectomy due to Ewing's sarcoma. Since the multi-modality treatment improves survival, the number of women with Ewing's sarcoma who desire pregnancy is expected to increase in the future. This is a valuable case that will provide useful information for such patients.     

A case of chronic paclitaxel administration in ovarian cancer

BACKGROUND: Treatment with chemotherapeutic agents, after initial ovarian tumor debulking, and during recurrence, results in extended chemotherapy. When ovarian cancer recurs, chemotherapy is continued when patients respond to therapy. However, the disease may become stable. Stable disease is clinically relevant and no longer an indication of treatment failure. CASE: A woman with advanced ovarian cancer was treated with cytoxan and cisplatin chemotherapy after having surgical cytoreduction. She progressed and was placed on monthly intravenous paclitaxel. After an initial partial response to therapy, she then went into a prolonged stable course of her disease. She subsequently received 67 cycles of monthly paclitaxel therapy. CONCLUSION: Chronic administration of paclitaxel resulted in prolonged stabilization of disease and was well tolerated.     

A case of Müllerian adenosarcoma of the uterus treated with liposomal doxorubicin

OBJECTIVE: We report on a case of uterine a denosarcoma responsive to treatment with liposomal doxorubicin (Doxil). METHODS: The clinical course, histopathology, and radiologic studies of the case were reviewed and are reported. RESULTS: A 69-year-old woman presented to our institution with dehydration and failure to thrive, and recurrent uterine adenosarcoma, 9 months after initial diagnosis. She had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy at the time of diagnosis, followed by two cycles of Ifosfamide and treatment with megestrol acetate. The patient presented to our institution for hospice care placement, severely dehydrated and with lethargy and with recurrent disease in the pelvis and vagina. She underwent treatment with six cycles of liposomal doxorubicin with a marked response. Given the development of Grade II hand-foot syndrome, liposomal doxorubicin was stopped and two cycles of carboplatin/paclitaxel chemotherapy were administered. Given the patient's disease progression on this regimen, surgical cytoreduction for localized recurrent disease was then performed. The patient developed disease recurrence after a 7-month disease-free interval and 2 years after initial diagnosis. Following another two cycles of liposomal doxorubicin, the patient underwent another cytoreductive procedure for recurrent disease. Two months later, the patient expired, 29 months after diagnosis and 20 months after initial treatment with liposomal doxorubicin chemotherapy. CONCLUSIONS: Liposomal doxorubicin appears to be active in the treatment of recurrent uterine adenosarcoma.     

Neoadjuvant chemotherapy followed by radical hysterectomy for invasive cervical cancer diagnosed during pregnancy: report of a case and review of the literature

Although cervical carcinoma is among the most frequently encountered malignancies during pregnancy, only four cases of neoadjuvant chemotherapy during pregnancy have been reported. A 28-year-old A0P1G2M0 was diagnosed at 15 weeks with stage Ib1 invasive squamous cervical cancer. Because she strongly desired the continuation of this pregnancy, after extensive counseling she was treated with 75 mg/m(2) cisplatin every 10 days starting at 17 weeks. After six cycles, clinically and radiologically stable disease with normalization of the squamous cell carcinoma tumor marker was obtained. An elective cesarean delivery followed by radical hysterectomy and lymphadenectomy was performed at 32 weeks gestation. The pathology report revealed a moderately differentiated squamous cell carcinoma of 3.5 cm, and all 33 lymph nodes were free of disease. Neonatal examination of the baby could not reveal any abnormalities, and this was confirmed at 6 months. The use of neoadjuvant chemotherapy enabled us to continue this pregnancy until the fetus was viable. Cisplatin did not influence the short-term outcome, but only a long-term follow-up will inform us on its safety during pregnancy.     

Endometrial carcinoma with laparotomy wound recurrence: complete remission following surgery and chemotherapy consisting of paclitaxel and carboplatin

We present a patient with surgical stage I endometrial cancer who experienced laparotomy wound recurrence 4 years after primary treatment. She was treated successfully by complete surgical resection of recurrent tumors and chemotherapy. A 62-year-old white female with laparotomy wound recurrence of endometrial carcinoma with small-bowel involvement and concomitant subcutaneous metastasis in the abdominal wall underwent complete surgical resection of metastatic tumors followed by six cycles of chemotherapy consisting of paclitaxel (175 mg/m2) and carboplatin (area under the curve 5). Since 24 months after resection of recurrence, she has no evidence of disease recurrence. Endometrial carcinoma with laparotomy wound recurrences, especially those with concomitant metastases, can be successfully treated by complete surgical resection followed by chemotherapy consisting of paclitaxel and carboplatin.     

Complete remission of an endometrial carcinoma with bilateral multiple pulmonary and extrapelvic metastases treated by surgery and chemotherapy consisting of paclitaxel and carboplatin

Successful management of a patient with endometrioid type, grade 2 endometrial carcinoma with bilateral multiple pulmonary and extrapelvic abdominal metastases has been reported. A 61-year-old woman with the preoperative diagnosis of stage IVB endometrial carcinoma underwent surgery followed by six cycles of chemotherapy consisting of paclitaxel (175 mg/m2) and carboplatin (area under curve 5). After the sixth course, there were no abnormal findings on chest and abdominal computed tomography. She has no evidence of disease recurrence 24 months after the induction of chemotherapy. Tumor markers are within normal limits. Endometrial carcinoma with pulmonary metastases, especially those with bilateral multiple pulmonary metastases associated with additional extrapulmonary spread can be successfully treated by extensive surgery followed by chemotherapy consisting of paclitaxel and carboplatin.     

The use of paclitaxel and cisplatin in a patient with epithelial ovarian cancer and human immunodeficiency virus

OBJECTIVE: Several spots exist of human immunodeficiency virus (HIV)-positive patients developing epithelial ovarian cancer. The optimal chemotherapeutic regimen has been unclear due to potential immunotoxicity from chemotherapy in these already immunocompromised patients. This is the first report of paclitaxel-based combination chemotherapy in an HIV-positive patient with ovarian cancer. METHOD: A 39-year-old woman with HIV was diagnosed with poorly differentiated serous carcinoma. She underwent optimal cytoreductive surgery and received six courses of paclitaxel and cisplatin. RESULTS: The patient experienced a complete clinical response to therapy with no adverse effect on surrogate markers for human immunodeficiency virus (CD4 count, beta2 microglobulin, neopterin, p24 antigen, and viral load). CONCLUSION: Paclitaxel- and platinum-based chemotherapy, the standard of care for adjuvant chemotherapy in advanced ovarian carcinoma, is appropriate therapy for ovarian cancer patients with HIV. There is no evidence that the paclitaxel/cisplatin regimen is associated with progression of HIV or increased chemotherapy-associated morbidity.     

Recurrence of phaeochromocytoma in pregnancy in a patient with multiple endocrine neoplasia 2A: a case report and review of literature

Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant inherited condition with a prevalence of one in 40?000 individuals. It causes the development of tumours in endocrine glands, such as medullary thyroid cancer, pheochromocytomas, as well as primary hyperparathyroidism. MEN 2A in pregnancy is very rare with only 29 cases reported in the literature. The presence of pheochromocytoma is a rare cause of hypertension during pregnancy with an incidence of 0.007% of all pregnancies. This has severe implications on both mother and the foetus. This case report describes a 22-year-old nulliparous Caucasian woman with known MEN2A syndrome, who underwent thyroidectomy for medullary thyroid carcinoma in childhood and excision of left sided pheochromocytoma at the age of 19. She was found to have a recurrence of pheochromocytoma in the right adrenal gland during pregnancy at 16 weeks of gestation and was oddly normotensive. Catecholamine effects were blocked with phenoxybenzamine and she delivered by an uneventful elective caesarean section at 36 weeks gestation. She underwent a laparoscopic right adrenalectomy six weeks postpartum, followed by lifelong corticosteroid replacement.     

Leukemia in pregnancy and fetal response to multiagent chemotherapy

Background: Leukemia is rare in pregnancy and treatment with intensive, multiagent chemotherapy produces complete remission in most adults, but might have deleterious effects on fetuses.Case: A 24-year-old gravida 3 para 2 presented at 24 weeks with pruritus, rash, pancytopenia, and hepatitis. A bone marrow biopsy found acute lymphocytic leukemia. She completed three cycles of intensive multiagent chemotherapy with transient oligohydramnios in each cycle. Although there was decreased fetal growth rate, umbilical artery Doppler scans were normal. She delivered a normal 2150-g male infant at 36 weeks.Conclusion: Pregnant women with newly diagnosed leukemia should not delay treatment, but multiagent chemotherapy might have transient effects on fetuses, most notably oligohydramnios. However, if fetal testing is normal, delivery might not be indicated.     

Yolk sac tumor of the ovary during pregnancy: a case report

BACKGROUND: There is a therapeutic dilemma for the pregnant patient with malignancy requiring chemotherapy. CASE: We had a case of a 30-year-old pregnant woman with a yolk sac tumor who underwent right salpingo-oophorectomy at 22 weeks gestation. Chemotherapy during pregnancy was postponed because of concern with the risks of the chemotherapy to the fetus. After the operation, L2 fraction of alpha-fetoprotein (AFP) depending on the affinity for Lens culinaris agglutinin (LCA) as an indicator for a maternal source of AFP had been detectable since 30 weeks gestation and elevated rapidly with advancing gestation. Tumor recurrence was confirmed clinically at 34 weeks gestation. She was induced, delivering a healthy baby, and received seven complete chemotherapy courses (cisplatin, etoposide, and peplomycin). Currently, the mother (39 months after last chemotherapy) and child are doing well. CONCLUSION: AFP-L2 may be a sensitive indicator for a yolk sac tumor derived AFP, leading to an earlier detection of tumor recurrence during pregnancy.     

Chemoradiation therapy in pregnant patients treated for advanced-stage cervical carcinoma during the first trimester of pregnancy: report of two cases

Two patients treated using chemoradiation therapy (CRT) (with fetus in utero) for advanced-stage squamous cell cervical carcinoma diagnosed during the first trimester of pregnancy are reported. One patient with a stage IVA disease diagnosed at 12 weeks of gestation was treated by exclusive CRT with the fetus in utero. She recurred 20 months after the end of the treatment. The second patient had a stage IIB disease diagnosed at 12 weeks of gestation and was treated by CRT with the fetus in utero followed by completion surgery (radical hysterectomy and para-aortic lymphadenectomy) due to the presence of a suspicious residual disease. No residual disease was observed during the histologic analysis of hysterectomy and nodes specimens. This patient is alive and free of disease 24 months after surgery. Our observations could suggest that CRT in pregnant patients with fetus in utero is feasible without major short-term toxicity. Such management could be proposed in patients with a bulky cervical cancer diagnosed during the first trimester of the pregnancy. Management of the uterine evacuation depends on the local tumor spread.     

Phase II study of sequential doublets: topotecan and carboplatin, followed by paclitaxel and carboplatin, in patients with newly diagnosed advanced ovarian cancer

OBJECTIVE: Incorporating topotecan into standard platinum/taxane chemotherapy for advanced ovarian cancer has been complicated by myelosuppression. This study evaluated sequential doublets of topotecan and carboplatin, followed by paclitaxel and carboplatin, in newly diagnosed advanced ovarian cancer patients. METHODS: Forty-five patients (median age, 56 years; range, 38-77 years) with stage III/IV disease and GOG performance status <2 were enrolled and received four cycles of topotecan (1.0 mg/m(2)/day on days 1 to 3) and carboplatin (AUC 4 on day 1), followed by four cycles of paclitaxel (175 mg/m(2) via 3-h IV infusion on day 1) and carboplatin (AUC 5 on day 1). All cycles were 21 days. Antitumor response was assessed after four and eight cycles; patients with clinical complete response (CR) underwent second-look laparotomy for determination of pathologic CR (PCR). Dose reductions were instituted for grade 4 neutropenia and thrombocytopenia, and for grade 3/4 nonhematologic toxicity. RESULTS: Among 41 CA-125 evaluable patients, complete and partial responses were observed in 29 (70.7%) and 11 (26.8%) patients, respectively. Of the 12 clinical CRs (43%) in 28 evaluable patients, 10 patients underwent second-look laparotomy, with 3 PCRs (30%). Median time to progression was 14 months and actuarial survival was 23 months. Neutropenia was the primary toxicity and cause of dose adjustments and delays, including two deaths. CONCLUSION: The antitumor activity observed is comparable with other series, although neutropenic complications were increased. Progression-free and actuarial survivals were slightly inferior. A Phase III trial (GOG 182) of sequential doublets in the reverse sequence is ongoing.