A new ASCO guideline provides recommendations on managing cancer during pregnancy, addressing a range of topics from the selection and timing of diagnostic testing and therapeutic interventions to delivery planning and ethical and legal considerations.1
The guideline aims to inform evidence-based care pathways in order to optimize outcomes for the pregnant patient and, if the pregnancy is continued, for their embryo or fetus. Developed by a multidisciplinary Expert Panel, the guideline was designed to be a resource for a range of clinicians caring for pregnant patients with cancer and to mitigate disparities in care by reaching a wide audience.
Alison W. Loren, MD, MSCE, MS, FACP, FASCO
Ann H. Partridge, MD
Cancer during pregnancy is uncommon, but its incidence is increasing with the combined trends of pregnancy at later age and an earlier onset of some cancers. These intersecting trends, along with the understandable absence of randomized trials for this population, led to a “growing need to articulate what we think [are] the best practices or best judgment,” explained Guideline Co-chair Alison W. Loren, MD, MSCE, MS, FACP, FASCO, of the Perelman School of Medicine at the University of Pennsylvania.
“We developed this guideline to help providers, and therefore patients, understand what’s safe and what’s not safe [and] what’s known and what’s not known,” explained Guideline Co-chair Ann H. Partridge, MD, MPH, FASCO, of the Dana-Farber Cancer Institute, “and how we can best guide the optimal care of patients and their families who are dealing with this clinical dilemma.”
The co-occurrence of cancer and pregnancy “is a devastating combination of the most important life events that a person could experience,” Dr. Loren said. “When these two collide in a young person who doesn’t see it coming, it’s extremely high stakes and high emotions.”
She added that it can be “almost paralyzing” for the team caring for the pregnant patient too. In developing the guideline, the authors hope to provide a roadmap for clinicians navigating this complex situation. An overview of key recommendations is shown in the Table.
KEY POINTS
- Cancer during pregnancy is uncommon but increasing in frequency with the co-occurring trends of pregnancy at later age and an earlier onset of some cancers.
- A new ASCO guideline provides recommendations on the management of cancer during pregnancy.
- The guideline addresses the selection and timing of diagnostic testing and therapeutic interventions, delivery planning, and ethical and legal considerations.
Dr. Loren added that more information is available today about what therapies can be tolerated by a pregnant patient and by the growing fetus, allowing a more nuanced discussion regarding the risks and benefits of different therapeutic approaches. However, because cancer during pregnancy is so rare, the literature is “both vast and limited,” explained Dr. Partridge. The guideline distills the available information to best support clinicians and patients in navigating these decisions.
For patients in advanced pregnancy, there has been an evolution in thinking about the optimal timing of delivery to maximize outcomes for both the pregnant patient and the fetus, in light of an increasing appreciation of the risks of early delivery. The guideline reflects “a meeting of the minds from maternal-fetal medicine and medical oncology,” Dr. Loren explained, “trying to articulate what the risks are while still allowing the patient and the team to determine what is an acceptable risk.”
The guideline also addresses ethical and legal considerations and provides recommendations to help support a patient’s decision to continue or end their pregnancy, which the co-chairs noted is particularly relevant considering new restrictions on access to safe termination in many states.
Looking ahead, Dr. Loren noted that there is a need for additional studies modeling the toxicities of cancer-directed therapies to better understand the implications of different therapies. Registry data will also continue to be essential for evaluating the safety and efficacy outcomes of different management approaches for pregnant patients with cancer.
REFERENCE
1. Loren AW, Lacchetti C, Amant F, et al. Management of cancer during pregnancy: ASCO guideline. J Clin Oncol. Published online December 11, 2025. https://doi.org/10.1200/JCO-25-02115.
Originally published in ASCO Daily News. © American Society of Clinical Oncology. ASCO Daily News, December 11, 2025. All rights reserved.
