Pearls
- Anthracyclines are safe and should be done q 3 weeks not DDAC
- Taxanes are now considered safe, but may need higher doses due to placental breakdown
- Platinum agents are safe, but low albumin levels can lead to toxicity
- 5FU and xeloda safe, but no clear role in pregnancy
- Contraindicated in pregnancy and lactation: trastuzumab, ADC, PARP inhibitor, methotrexate( pregnancy)
- Endocrine therapy is contraindicated
- Supportive care: Reglan ( safe) promethazine ( safe), olanzapine for highly emetogenic regimens. Dexamethasone can cross the placenta and affect fetal head growth ( short term use ok).
- Insufficient data re: safety of bisphosphonates, CDK4/6 inhibitor HER 2 TKI, IO, use of growth factors
Radiation: contraindicated
When to resume chemo post delivery:
- 2 weeks after vaginal delivery and 4 weeks after C section.
- Use DVT prophylaxis with lovenox for 6 weeks
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