Title : A review of evidence, safety and clinical considerations in taxane chemotherapy in pregnancy associated breast cancer
Abstract:
Background: 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, cyclophosphamide). High-risk breast cancer subtypes such as triple-negative breast cancer (TNBC) and 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: The PubMed and Scopus databases were searched for studies that included case series, cohort studies, and clinical guidelines that discuss taxane chemotherapy in pregnancy between 2000 and 2025. Animal experiments, chemotherapy agents other than taxanes and review articles were not included in the analysis. The collected data included administration timing and maternal and fetal results and cancer subtype indications.
Results: The molecular weight and protein binding properties of paclitaxel and docetaxel reduce their placental transfer. The agent with the most research has not demonstrated a higher rate of congenital anomalies when given after the first trimester of pregnancy, yet the delivery of preterm babies and low birth weight babies and temporary neonatal neutropenia were found. The available information regarding docetaxel administration shows no increase in major malformations. The most common approach used to treat TNBC and HER2-positive tumors (without concurrent trastuzumab) 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 with neuropathy, neutropenia and fatigue. The survival rates of appropriately treated PABC patients match those of nonpregnant patients. Data regarding the long-term developmental outcomes of children remain limited.
Conclusion: Taxanes, particularly paclitaxel, can be used with caution after the first trimester in PABC patients, especially in high- risk cases following anthracycline treatment. The absence of randomized trials combined with limited developmental data necessitates both postnatal follow-up and registry-based surveillance for the children. The decision-making process must consider individual factors such as gestational age, tumor biology, and maternal-fetal benefit-risk assessment.
