INTRODUCTION: Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. MATERIAL AND METHODS: Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. RESULTS: In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6-30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. CONCLUSIONS: The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account.

Center for Gynecological Oncology Amsterdam Antoni van Leeuwenhoek Netherlands Cancer Institute Amsterdam The Netherlands

Center for Gynecological Oncology Amsterdam Antoni van Leeuwenhoek Netherlands Cancer Institute Amsterdam The Netherlands Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands

Clinic of Obstetrics and Gynecology University of Milan Bicocca San Gerardo Hospital Monza Italy

Department of Medical Oncology Erasmus MC Cancer Institute Erasmus University Medical Center Rotterdam The Netherlands

Department of Medical Oncology Radboud University Nijmegen Medical Center Nijmegen The Netherlands

Department of Medical Oncology Utrecht Cancer Center University Medical Center Utrecht Utrecht The Netherlands

Department of Obstetrics and Gynecology Cooper University Health Care Camden NJ USA

Department of Obstetrics and Gynecology University Hospitals Leuven Leuven Belgium Department of Oncology KU Leuven Leuven Belgium

Department of Obstetrics Cliniques Universitaires St Luc UCL Sint Lambrechts Woluwe Belgium

Department of Obstetrics University Hospitals Leuven Leuven and Department of Development and regeneration KU Leuven Leuven Belgium

Department of Oncology KU Leuven Leuven Belgium Center for Gynecological Oncology Amsterdam Antoni van Leeuwenhoek Netherlands Cancer Institute Amsterdam The Netherlands Center for Gynecological Oncology Amsterdam Amsterdam University Medical Centers Amsterdam The Netherlands

Faculty Hospital Kralovske Vinohrady and 3rd Medical Faculty Charles University Prague Czech Republic

Gynecologic Oncology Bichat University Hospital Paris Diderot University Paris France

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$a Gastric cancer during pregnancy: A report on 13 cases and review of the literature with focus on chemotherapy during pregnancy / $c C. Maggen, CA. Lok, E. Cardonick, M. van Gerwen, PB. Ottevanger, IA. Boere, M. Koskas, MJ. Halaska, R. Fruscio, MM. Gziri, PO. Witteveen, K. Van Calsteren, F. Amant, International Network on Cancer, Infertility and Pregnancy (INCIP),

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$a INTRODUCTION: Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. MATERIAL AND METHODS: Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. RESULTS: In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6-30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. CONCLUSIONS: The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account.

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$a Cardonick, Elyce $u Department of Obstetrics and Gynecology, Cooper, University Health Care, Camden, NJ, USA.

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$a van Gerwen, Mathilde $u Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands. Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.

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$a Ottevanger, Petronella B $u Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.

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$a Van Calsteren, Kristel $u Department of Obstetrics, University Hospitals Leuven, Leuven and Department of Development and regeneration, KU Leuven, Leuven, Belgium.

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