How much platinum passes the placental barrier? Analysis of platinum applications in 21 patients with cervical cancer during pregnancy.
OBJECTIVE
Cervical cancer is the most common solid cancer diagnosed in pregnancy. Platinum is an active drug in the treatment of patients with cervical cancer. In the second and third trimesters, platinum is used to prevent cancer progression until fetal maturity is reached. However, knowledge about the transplacental passage of platinum is very limited.


METHODS
Between May 2008 and June 2014, platinum-based neoadjuvant chemotherapy was applied to 21 consecutive patients with cervical cancer diagnosed in their second trimester. At the time of delivery by cesarean delivery, synchronous samples from maternal blood, umbilical cord blood, and amniotic fluid were taken and analyzed for platinum concentrations.


RESULTS
The mean week of gestation at cancer diagnosis was 17 (13-23). On average 3 (range, 2-4) cycles of chemotherapy were applied. Cesarean deliveries were carried out between 30.4 and 36.5 weeks of gestation. Twenty-two healthy babies without renal, hepatic, auditory, or hematopoietic impairment were delivered. Platinum concentrations in umbilical cord blood and amniotic fluid were 23-65% and 11-42% of the maternal blood, respectively.


CONCLUSIONS
This series on in vivo measurement of platinum concentrations in the fetomaternal compartment observed that because of consistently lower platinum values in the fetoplacental unit, a placental filtration mechanism of platinum may be assumed.
Department of Advanced Gynecologic Surgery and Oncology, Asklepios Hospital Hamburg, Hamburg, Germany. Electronic address: ch.koehler@asklepios.com.
Christhardt
C
Köhler
Department of Gynecology and Obstetrics, Women and Children Hospital Linz; and Medical Faculty of Johannes Kepler University Linz, Linz, Austria.
Peter
P
Oppelt
Department of Advanced Gynecologic Surgery and Oncology, Asklepios Hospital Hamburg, Hamburg, Germany.
Giovanni
G
Favero
Department of Gynecology, University Hospital Cologne, Cologne, Germany.
Bernd
B
Morgenstern
Department of Gynecology, University Hospital Jena, Jena, Germany.
Ingo
I
Runnebaum
Department of Gynecologic Oncology, Hospital de Cãncer de Barretos, Barretos, Brazil.
Audrey
A
Tsunoda
Ambulatory Oncologic Health Care Center Berlin Seestrasse, Berlin, Germany.
Alexander
A
Schmittel
Institute for Cytologie and Dyplasia, Fürstenberg-Karree Berlin, Berlin, Germany.
Achim
A
Schneider
Department of Gynecology, University Hospital Bern, Bern, Switzerland.
Michael
M
Mueller
Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Simone
S
Marnitz
D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry*; D000970:Antineoplastic Agents / Q000032:analysis / Q000378:metabolism* / Q000627:therapeutic use; D016190:Carboplatin / Q000032:analysis / Q000378:metabolism* / Q000627:therapeutic use; D002585:Cesarean Section; D002945:Cisplatin / Q000032:analysis / Q000378:metabolism* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D008431:Maternal-Fetal Exchange; D020360:Neoadjuvant Therapy; D010920:Placenta / Q000378:metabolism*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy*; D011256:Pregnancy Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy*
D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin
cervical cancer; neoadjuvant chemotherapy; platinum concentration; pregnancy; transplacental transport