毒理性
◉ 母乳喂养期间的总结：大多数来源认为，在母体抗肿瘤药物治疗期间，母乳喂养是禁忌的。在经过一段适当的断奶期后，间歇性使用依托泊苷可能安全地进行母乳喂养。在每平方米80毫克或更少的剂量后，需要至少24小时的间歇期。其他一些意见建议在使用依托泊苷后应有72小时的断奶期。化疗可能会不利地影响母乳的正常微生物组和化学成分。在怀孕期间接受化疗的妇女更可能在哺乳婴儿时遇到困难。
◉ 对哺乳婴儿的影响：一位母亲接受了5天的依托泊苷80毫克/平方米和静脉注射的阿糖胞苷170毫克/平方米，以及3天的静脉注射米托蒽醌6毫克/平方米。她在第三次米托蒽醌给药后3周恢复母乳喂养婴儿，当时米托蒽醌在乳汁中仍可检测到。婴儿在16个月大时没有明显的异常。
◉ 对泌乳和母乳的影响：对74名在第二或第三孕期在一家中心接受癌症化疗的妇女进行了电话随访研究，以确定她们产后是否成功进行母乳喂养。只有34%的妇女能够完全母乳喂养她们的婴儿，而66%的妇女报告称遇到母乳喂养困难。与此相比，22位在怀孕期间被诊断出患有癌症但未接受化疗的母亲中，有91%成功进行了母乳喂养。其他具有统计学意义的相关性包括：1. 遇到母乳喂养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. 遇到母乳喂养困难的母亲在怀孕期间平均提前3.4周接受了她们的第一个化疗周期。在接受了含有紫杉烷类药物方案的9名妇女中，有7人遇到了母乳喂养困难。
◉ Summary of Use during Lactation:Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It might be possible to breastfeed safely during intermittent therapy with etoposide after an appropriate period of breastfeeding abstinence. A period of at least 24 hours is required after a dose of 80 mg/sq. m. or less. Others have suggested an abstinence period of 72 hours after etoposide use. 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.
◉ Effects in Breastfed Infants:One mother received with 5 daily doses of etoposide 80 mg/sq. m. and cytarabine 170 mg/sq. m. intravenously as well as 3 daily doses of 6 mg/sq. m. of mitoxantrone intravenously. She resumed breastfeeding her infant 3 weeks after the third dose of mitoxantrone at a time when mitoxantrone was still detectable in milk. The infant had no apparent abnormalities at 16 months of age.
◉ 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 9 women who received a taxane-containing regimen, 7 had breastfeeding difficulties.
来源:Drugs and Lactation Database (LactMed)
