Landscape and Regulatory Perspective on Oncology Drugs in Pregnancy

• Published in: Journal of clinical pharmacology Vol. 63 Suppl 1; p. S170
• Main Authors: Leong, Ruby, Grimstein, Manuela, DeMaria, Peter, Norsworthy, Kelly J, Fletcher, Elimika Pfuma, Shord, Stacy
• Format: Journal Article
• Language: English
• Published: England 01.06.2023
• Subjects: Breast Neoplasms; Female; Humans; Melanoma; Pregnancy; Thyroid Neoplasms; PBPK; Special Populations; Women's Health; Clinical Pharmacology (CPH); Oncology (ONC)
• ISSN: 1552-4604
• DOI: 10.1002/jcph.2224

Cancers affecting pregnant women include breast cancer, melanoma, thyroid cancer, cervical cancer, lymphomas, and leukemias. The medical management of cancer during pregnancy with molecularly targeted oncology drugs remains quite challenging, with knowledge gaps about the drugs' safety and efficacy due to exclusion of pregnant women from cancer clinical trials, discontinuation of individuals who become pregnant during clinical trials, and limited information on appropriate dosing of molecularly targeted oncology drugs during pregnancy. Physiological changes occur during pregnancy and may result in alterations in the absorption, distribution, metabolism, and excretion of drugs used in pregnant women. Physiologically based pharmacokinetic modeling that incorporates physiological changes induced by both the cancer disease state and pregnancy has the potential to inform dosing of molecularly targeted oncology drugs for pregnant women, improve our understanding of the pharmacokinetic changes associated with pregnancy in patients with cancer, facilitate the design of potential studies of molecularly targeted oncology drugs in pregnant women to support dosing recommendations, and provide model-informed pharmacokinetic data to support regulatory decision making.