Efficacy of Neoadjuvant Chemotherapy for Locally Invasive Cervical Cancer During Pregnancy: An Updated Systematic Review

Background & Objective: The management of cervical cancer during pregnancy is significantly challenging. This systematic review summarises the data on chemotherapy agents (platinum and taxanes) for the management of cervical cancer during pregnancy. Materials & Methods: Two independent investigators searched the literature and extracted data from all studies that examined the efficacy and safety of platinum and taxanes in managing cervical cancer during pregnancy. A quantitative analysis of the published articles was performed and Kaplan–Meier survival curves were estimated to determine the overall and progression-free survival. Results: Overall, 43 studies with 114 patients were included in this systematic review. All patients received neoadjuvant chemotherapy during pregnancy; the majority received platinum-based chemotherapy. Cisplatin was the main platinum-based chemotherapy agent in 56 patients (49%), followed by combined platinum and paclitaxel therapy in 41 patients (36%). A few patients were treated with single-agent vincristine and two patients by platinum with external beam radiation therapy. Bleomycin and 5-fluorouracil were administered to two patients. The most frequent complications were grade 2 thrombocytopenia and grade 3 hepatotoxicity in 32 (28%) and 18 (20.5%) cases, respectively. The common fetal complications were low birth weight and growth restriction. Chemotherapy was well tolerated by most women in the case group. The progression-free survival was 35% (n = 22). Conclusion: Platinum and taxane neoadjuvant chemotherapy has proven to be safe and effective in preventing cervical cancer disease progression until definitive surgical treatment.