Chemotherapy and pregnancy

Chemotherapy is the most common treatment used during pregnancy. The drugs destroy cancer cells, but they also affect healthy cells. It is natural to feel anxious about the possible effects of chemotherapy on the baby. But at the same time, you may want to start treatment.

You can usually start chemotherapy after you are 14 weeks pregnant. At this stage, research shows most chemotherapy drugs will not harm the baby. Doctors avoid giving certain chemotherapy drugs that could be harmful to the baby.

The placenta acts as a barrier between you and the baby. Some drugs cannot pass through the placenta. Others only pass through in very small amounts. Your specialist doctor and specialist nurse can explain this to you.

Having chemotherapy

You have chemotherapy as an injection or a drip (infusion) into a vein, or as tablets. This is the same for women who are not pregnant.

We have more information about how chemotherapy is given.

It may be helpful to talk to a woman who has had chemotherapy during pregnancy. Mummy’s Star or your cancer doctor or nurse can help you with this.

When you stop chemotherapy

Chemotherapy is not usually given after you are 37 weeks pregnant. You have a break between your last dose of chemotherapy and your expected delivery date. This avoids the baby being born when your blood cell levels are still low. Having a low level of blood cells is a temporary side effect of chemotherapy. Some women may have more chemotherapy after the baby is born.

If your baby is born soon after your chemotherapy finishes, doctors can give you drugs to support your immune system. This helps you fight infections.

You may have chemotherapy before or after surgery to remove breast cancer. Doctors use the same drugs they give to women with breast cancer who are not pregnant. You usually have either of the following anthracycline drugs with other chemotherapy drugs:

• doxorubicin (Adriamycin®)
• epirubicin.

Sometimes other drugs called taxanes are used. Docetaxel (Taxotere®) or paclitaxol (Taxol®) are less commonly given in pregnancy. You may have them nearer the end of chemotherapy. This often means you have them after the baby is born.

You might have other treatments after the baby is born. These include radiotherapy, hormonal and targeted therapy drugs.

Chemotherapy can be used to treat fast growing NHL during pregnancy. There is a standard combination of chemotherapy drugs used, called CHOP. It can be given in pregnancy.

Rituximab is a targeted therapy drug that is usually given with CHOP. Doctors often wait until after the baby is born to give it to you.

You may need chemotherapy to destroy all the cancer cells for acute myeloid leukaemia (AML). This is called induction chemotherapy. You can have the drugs that are usually given in this treatment. These are daunorubicin and cytarabine.

Acute promyelocytic leukaemia (APL)

This is a rare type of AML, which is treated in a different way. The first treatment for APL is a drug called ATRA. This is also known as tretinoin (Vesanoid).

APL needs to be treated very quickly. There is a risk of having a serious bleed without treatment. ATRA can reduce leukaemia symptoms very quickly. It is usually given with chemotherapy or a drug called arsenic trioxide.

You cannot have ATRA during the first 12 weeks of pregnancy. Unless APL is diagnosed later in pregnancy, doctors may recommend ending the pregnancy. This is so you can get the most effective treatment. If you decide to continue with the pregnancy, ATRA is usually given on its own.