We would like to thank Dr Berveiller and colleagues for their letter in response to our recent review of cancer in pregnancy for the generalist. While this review was meant to serve as a general reference for the treatment of various malignancies during pregnancy, we are prepared to respond to the raised concerns regarding the safety of platinum-based chemotherapy and cyclophosphamide outlined by Dr Berveiller and colleagues, although, as cited in the article, these topics are beyond the intended scope of this particular review.

The above-mentioned letter reported that we “assume that platinum may be particularly used with minimal fetal consequences.” In reality, we stated that platinum adducts, among other chemotherapy agents, have “the lowest associated risks.” We did not mean to imply that that there are not risks to the fetus. We concede that there are data that support the presence of platinum chemotherapy agents in the fetomaternal compartment following delivery. Despite the presence of these agents, it is important to note that there were significantly lower cisplatin concentrations in fetal compartment compared to the maternal compartment, with cisplatin concentrations in the umbilical cord and amniotic fluid of 31-65% and 13-42% of the amount in maternal blood, respectively. Additionally, the neonatal and pediatric follow-up, while limited given the study population, has overall been reassuring, with appropriate birthweights, Apgar scores, and hematologic, renal, auditory, liver, and neurologic parameters at the time of delivery. Limited data are available for the pediatric population, although in a review by Amant et al, they describe unremarkable neonatal and pediatric adolescent evaluations of 36 children after in utero exposure to platinum-based chemotherapy except for 2 patients (who were treated with other potentially toxic drugs concurrently).

Similarly, we stated in our review that alkylating agents (eg, cyclophosphamide) were found to have the greatest risk for adverse pregnancy outcomes, particularly first-trimester malformations. We concede that there are data to support the use of these agents in the second and third trimesters, but specifically, they should be avoided in the first trimester. We agree that the use of trastuzumab should be avoided in pregnancy, and appreciate the reminder.

The treatment of malignancy in pregnancy is difficult, weighing the risks and benefits to both mother and fetus. We appreciate the concerns raised by Dr Berveiller and colleagues, as they further illustrate the need for multidisciplinary treatment teams and specialists to improve the oncologic and obstetrical outcomes for both mother and fetus.