Using anti-cancer agents during the post-partum period: not that simple.

kinetic and pharmacodynamic changes during the first month following delivery. In the present issue of OnkOlOgie, Savvari et al. [8] report on a patient diagnosed with a Burkitt’s lymphoma with bilateral breast involvement. The diagnosis was made shortly after delivery, and the treatment was initiated during the next month. Despite disease-related liver dysfunction, the authors report a successful use of a multi-drug regimen, with adapted doses and omission of methotrexate. The diagnosis of breast malignancies during pregnancy is often difficult, and a delay in diagnosis is frequent [9]. For instance, in one series from the M.D. Anderson Cancer Center [10], the average delay in diagnosis in pregnant women was 8.2 months compared to 1.9 months in non-pregnant women. Burkitt’s lymphomas associated with pregnancy have a dismal prognosis, in particular when the diagnosis is made in early pregnancy, thereby making difficult the use of optimal dose-dense treatments [11]. Finally, the use of anti-cancer agents during the post-partum period (< 6 weeks after delivery) may be as challenging as their use during pregnancy. Although the fetal risk is by definition absent in this setting, the optimal maternal treatment should be tailored to the pharmacological properties of the drugs employed. Further studies in breast cancer patients receiving taxanes and anthracyclines in this period are on going, and may provide additional information in order to better handle anti-cancer agents in patients with pregnancy-associated malignancies.