毒理性
◉ 母乳喂养期间使用总结:大多数来源认为,接受抗癌治疗的母亲不应哺乳,尤其是使用诸如奥沙利铂等烷化剂。在一项患者中,发现最后一次给药后至少65天母乳中仍有铂。尚不清楚可能排入母乳中的铂的确切形式和毒性。哺乳婴儿会口服而非静脉注射任何铂化合物,婴儿对口服铂化合物的吸收情况尚不清楚。化疗可能对母乳的 normal microbiome 和化学成分产生不利影响。怀孕期间接受化疗的妇女更可能有哺乳困难。制造商建议,在接受奥沙利铂注射治疗期间以及最后一次给药后3个月内,妇女不应哺乳,这与一名患者乳汁中发现铂的发现一致。
◉ 对哺乳婴儿的影响:截至修订日期,未找到相关的已发布信息。
◉ 对泌乳和母乳的影响:在一项中心对74名在怀孕第二或第三季度接受癌症化疗的妇女进行电话随访研究,以确定她们产后是否成功哺乳。只有34%的妇女能够完全母乳喂养她们的婴儿,而66%的妇女报告遇到哺乳困难。与此相比,22名在怀孕期间诊断但未接受化疗的母亲中,有91%成功哺乳。其他具有统计学意义的相关性包括:1. 哺乳困难的母亲平均接受了5.5个周期的化疗,而没有困难的母亲平均接受了3.8个周期;2. 哺乳困难的母亲在怀孕期间平均提前3.4周接受了第一次化疗周期。在接受了含有类似药物顺铂方案的3名妇女中,有1人遇到哺乳困难。
◉ Summary of Use during Lactation:Most sources consider that mothers receiving antineoplastic therapy should not breastfeed, especially with alkylating agents such as oxaliplatin. In one patient, platinum was found in breastmilk for at least 65 days after her last dose. The exact form and toxicity of platinum that might be excreted into breastmilk are not known. The nursing infant would receive any platinum compounds orally rather than intravenously and oral absorption of oral platinum compounds by infants is not known. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant. The manufacturer recommends that women should not breastfeed during treatment with oxaliplatin injection and for 3 months after the final dose, which is consistent with findings of platinum in the milk of one patient.
◉ Effects in Breastfed Infants:Relevant published information was not found as of the revision date.
◉ Effects on Lactation and Breastmilk:A telephone follow-up study was conducted on 74 women who received cancer chemotherapy at one center during the second or third trimester of pregnancy to determine if they were successful at breastfeeding postpartum. Only 34% of the women were able to exclusively breastfeed their infants, and 66% of the women reported experiencing breastfeeding difficulties. This was in comparison to a 91% breastfeeding success rate in 22 other mothers diagnosed during pregnancy, but not treated with chemotherapy. Other statistically significant correlations included: 1. mothers with breastfeeding difficulties had an average of 5.5 cycles of chemotherapy compared with 3.8 cycles among mothers who had no difficulties; and 2. mothers with breastfeeding difficulties received their first cycle of chemotherapy on average 3.4 weeks earlier in pregnancy. Of the 3 women who received a regimen containing the similar drug, cisplatin, 1 had breastfeeding difficulties.
来源:Drugs and Lactation Database (LactMed)