Advances in Oncologic Therapies During Pregnancy: Balancing Maternal Cure With Fetal Safety in Reproductive Cancers

Gynecologic cancer during pregnancy requires treatment decisions that preserve maternal oncologic efficacy while minimizing fetal harm. This focused narrative review critically evaluates systemic therapy for cervical, ovarian, and other selected gynecologic malignancies during pregnancy, with surgery, radiotherapy, obstetric outcomes, and emerging technologies discussed only when they directly inform systemic-treatment decisions. Evidence is interpreted using a transparent four-category framework based on study design, consistency, directness, and applicability to pregnancy. The most consistent evidence supports avoiding cytotoxic chemotherapy during organogenesis and permits selected standard-dose regimens after the first trimester when maternal benefit justifies treatment. Anthracycline-, taxane-, and platinum-based regimens are supported predominantly by international cohorts, registries, and case series rather than randomized trials. Evidence for targeted agents and immune checkpoint inhibitors remains sparse, indirect, and vulnerable to reporting bias; therefore, these treatments should generally be deferred during pregnancy unless an individualized multidisciplinary assessment identifies a compelling maternal indication and no effective alternative. Nanomedicine remains preclinical and is summarized solely as a future research direction. This evidence-calibrated approach emphasizes indication-specific treatment, avoidance of iatrogenic prematurity, and prospective maternal and offspring follow-up.