Review of the potential effects of three commonly used antineoplastic and immunosuppressive drugs (cyclophosphamide, azathioprine, doxorubicin on the embryo and placenta)

CP, AZP and DOX are three commonly used antineoplastic and immunosuppressive drugs. Due to increasing incidence of pregnancies in older women, their use both as immunosuppressive and antineoplastics during pregnancy is rising. Many experimental animals data support the notion that these drugs are embryotoxic and teratogenic. However, human data is limited, and sometimes their use during pregnancy is mandatory. Considering pregnancy interruption prior to the necessary use of some of these drugs seems to be a debatable option but it should be offered to the pregnant women especially if CP treatment is required. One should therefore counsel these women according to the currently existing data. Those data suggests that CP is considered to be a threat for the first trimester of pregnancy and should not be used during that period unless it is the drug of choice for a particular illness. Very little information exists about the use of DOX during pregnancy. Thus, if possible, it should be avoided during the first trimester of pregnancy unless it is the drug of choice for a particular illness. The available human data, suggest that the risk for congenital anomalies as a result of 6-MP treatment early in pregnancy is not high. Thus, AZP/6-MP may be used in pregnancy if the benefit clearly justifies the possible risk to the fetus. In order to further study the direct effects of the drugs on the human placenta and its regulators, human placental cultures and in vitro cultures of rodent embryos surrounded by their yolk sacs may be informative.