BACKGROUND: Platina and taxanes are frequently used chemotherapeutic agents to treat cancer, also when diagnosed during pregnancy. This report presents an interim analysis of the largest series of children prenatally exposed to platinum and/or taxane agents and aims to determine their physical health and neurocognitive outcomes. METHODS: As part of a multicentre, prospective cohort study (ClinicalTrials.gov: NCT00330447), children born between 2000 and 2022 were assessed between 2005 and 2024 at ages 1.5-18 years (interim analysis; median length of follow-up, 3.2 years (IQR 3.0-6.4)) by a comprehensive neurocognitive test battery, parent-reported questionnaires, and a physical assessment. Mixed-effects regression and Type III Analysis of Variance models were used to investigate associations between these outcomes and platinum/taxane cumulative dose and agent type, with best-fit models corrected for age and covariates (gestational age at birth, chemotherapy timing, other chemotherapy, sex, parental education level, maternal death). FINDINGS: In total, 144 children were included (13% exposed to platinum, 62% to taxanes, 25% to both). Of these, 101 were assessed at age 1.5 years, 96 at age 3, 63 at age 6, 32 at age 9, 18 at age 12, 7 at age 15, and 2 at age 18 years. Neurocognitive outcomes were within normal ranges across all ages, compared with test-specific normative data. Eight children (6%) reported ototoxicity, seven (5%) reported chronic medical conditions, three (2%) had congenital malformations, and two (1%) were diagnosed with Attention-Deficit Hyperactivity Disorder. Thirty-three children (23%) needed extra neurocognitive support, of which 64% were born preterm. Children prenatally exposed to paclitaxel scored lower on visuospatial (β = 0.64 ± 0.21, p = 0.0052) and verbal memory (β = 0.68 ± 0.27, p = 0.015) than those exposed to docetaxel. INTERPRETATION: In this interim analysis, we found normal neurocognitive outcomes and no increase in congenital malformations nor medical conditions after prenatal exposure to platinum/taxane-based chemotherapy. However, owed to the limited number of older children, further investigation regarding their potential neurotoxicity and its long term effects is necessary in follow-up studies with larger samples. FUNDING: Kom Op Tegen Kanker, KWF Kankerbestrijding, Stichting Tegen Kanker, Cooperatio program, Research Foundation Flanders.

Amsterdam Reproduction and Development Child Development Amsterdam the Netherlands

Center for Gynecological Oncology Netherlands Cancer Institute Amsterdam Netherlands

Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam UMC University of Amsterdam the Netherlands

Department of Clinical Sciences and Community Health University of Milan Milano Italy

Department of Development and Regeneration Unit of Woman and Child KU Leuven Belgium

Department of Medicine and Surgery Clinic of Obstetrics and Gynecology University of Milan Bicocca Fondazione IRCCS San Gerardo Monza Italy

Department of Obstetric Gynecology University Hospital Kralovske Vinohrady and 3rd Medical Faculty Charles University Prague Czechia

Department of Obstetrics and Gynaecology Unit of Foetomaternal Medicine UZ Leuven Belgium

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

Department of Oncology Unit of Gynaecological Oncology KU Leuven Belgium

Department of Oncology Unit of Pediatric Oncology KU Leuven Belgium

Department of Pediatrics Unit of Pediatric Hemato Oncology UZ Leuven Belgium

Department of Pediatrics Unit of Pediatric Neurology UZ Leuven Belgium

Division of Gynaecological Oncology Department of Obstetrics and Gynaecology UZ Leuven Belgium

Faculty of Psychology and Educational Sciences Unit of Clinical Psychology KU Leuven Belgium

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico NICU Milano Italy

Princess Máxima Center for Pediatric Oncology Utrecht Netherlands

University Medical Center Utrecht Wilhelmina Children's Hospital Division of Child Health Utrecht Netherlands

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ClinicalTrials.gov
NCT00330447