WHAT IS THE EVIDENCE TO CONTRAINDICATE BREAST-FEEDING OF AN INFANT WHOSE, MOTHER IS ON PLATINUM BASED CHEMOTHERAPY?

摘要

Background: Unfortunately the burden of cancer is not age limited, so that women at productive age may also suffer from some sort of malignancy. The challenge to use cytostatics in pregnant is limiting factor due to possible damage to offspring. Platinum based chemotherapy is proved to be effective in variety of solid tumors, including those of the urogenital system. Cis-diamminedichloroplatinum (CDDP) is the first member of a class of platinum-containing anti-cancer drugs used to treat various types of cancers, including womb, cervical and ovarian cancer, lymphomas, and germ cell tumors. The platinum complex reacts in vivo, binding to and causing cross linking of DNA ultimately triggering apoptosis (programmed cell death). In the neoadjuvant therapy protocol, the use of cisplatin or carboplatin in combination with other cytostatics is reported, but the safety of the drug to the foetus and later to infant on breastfeeding is not well studied excerpt known from few sires of case reports including contradictory data whether platincomplex is significantly excreted into human milk or not. The main objective of this pilot study was to assess the detectability of cisplatin in milk samples from mothers on chemotherapy as well as in the umbilical cord blood post delivery compared to the quantity found in mother's blood. Methods: Two pregnant women with cervical cancer , who underwent cis-platin based chemotherapy were enrolled after written consent. Blood samples have been taken before the cisplatin infusion and after 2 hours lasting infusion during two subsequent 2 weekly cycles till 48 hours post dosing in case 1. Milk samples were also collected on day 1-4 after delivery along with the blood samples from ublical cord immediately after delivery to determine the concentration of platinum using automatic analyser Varian SpectrAA 220Z by means of atomic absorption spectrometric automation validated as flameless atomic absorption spectrophotometry (FAAS)method. Results: Concentrations of platinum in the defined samples were determined by atomic absorption spectrometric atomation. Measurement of platinum concentration in milk samples from women treated with cisplatin, who at the same time breastfeed their newborn babies revealed undetectable quantity. Plasma and whole blood concentrations of platin in mothers' samples and umblical vesells is meareable at all times post dose to last sampling (48 hours in case 1. The concentrated milk had detecteble concentrations of platin. Platinum in mothers' samples and umblical vesells is meareable at all times post dose to last sampling (48 hours in case 1. The concentrated milk had detecteble platinum only on 1st day after delivery but not from day 2 onwards. Platinum concentration from milk or ultrafltrate was undetectable atall. Thus there is no ground for detectable platinum in the blood samples of the breastfed newborns. In ionclusion, similar to the one very previous report our observation in two cases found no detectable quantity of cis-platin in breastfeeding mothers' milk indicating possible safety to breastfed baby. Even if some platinum is supposed to be excreted into milk or concentrated colostrum , its sgnificant reabsorption from gastrointestinal tract (GIT) is unlikely. All available reports are in favour of platinum as relatively safe drug during pregnancy with cautions. Based on our results and review of available literature reports, there is a reason to propose that mothers on cis-platin may consider breastfeed their babies since no quantifiable concentration is found in milk. Furthermore it is unlikely for platinum complexes to be reabsorbed from the oral route. However, decision making should follow individual managment manner.