ADN Fœtal Circulant, Grossesse et Pathologies Malignes (AFFEPAM)

In France in 2021, 90% of pregnant women chose to undergo screening for Trisomy 21, and 128,958 women benefited from a fetal aneuploidy screening test based on the analysis of cell-free DNA (cfDNA) in maternal blood.

At the beginning of its use, this analysis was limited to screening for Trisomy 21, but it now allows the study of all chromosomes (expanded screening). More than half of fetal chromosomal abnormality screenings are expanded tests, and this practice continues to grow.

In oncology, circulating tumor DNA (ctDNA) is studied for the detection, prognostic evaluation, and monitoring of the effectiveness of certain treatments. The high-throughput sequencing tools used for aneuploidy screening during pregnancy are likely to detect malignant diseases. Cancer is associated with pregnancy in 1 in 1,000 to 1 in 1,500 pregnant women, and the spread of expanded aneuploidy screening during pregnancy makes it possible to detect maternal cancers, including at infraclinical stages.

This study will therefore help manage situations involving difficult-to-interpret results, such as suspected maternal cancer.

It will make it possible to identify specific chromosomal abnormalities to be tested, which could potentially be included in future recommendations. In a second stage, it could contribute to harmonizing the practices of laboratory specialists performing fetal chromosomal abnormality screening using cfDNA.

Study Overview

• Status: Enrolling by invitation
• Conditions: Cancer; Femmes Enceintes
• Intervention / Treatment: Genetic: Collection of a sample

Detailed Description

Cancer is associated with pregnancy in 1 in 1,000 to 1 in 1,500 pregnant women,but the estimated incidence varies depending on whether cancers pre-existing before pregnancy, cancers diagnosed during pregnancy, and sometimes those discovered in the postpartum period are included. The cancers most frequently encountered in the context of pregnancy are breast cancer, cervical cancer, melanoma, and thyroid cancer.

In 2015, D. Bianchi's team⁵ was the first to report the possibility of incidentally detecting cancers in pregnant women during the analysis of circulating cell-free DNA (cfDNA) performed for fetal chromosomal abnormality screening. In a cohort of 125,426 tests, 10 maternal cancers were identified. Since then, around one hundred cases have been reported, most often as case reports or small series.

Maternal cancer may be suspected when the cfDNA test result (performed for trisomies 21, 18, and 13, or as part of expanded screening) shows either multiple chromosomal abnormalities or an abnormality known to be associated with a certain type of cancer, such as some lymphomas.

In oncology, circulating tumor DNA (ctDNA) is studied for cancer detection, prognostic evaluation, and monitoring the effectiveness of certain treatments. The presence of ctDNA has been known since 1989. It originates from cells of the primary tumor and reflects genetic alterations (copy number variations, somatic mutations, methylation changes, etc.). The amount of ctDNA depends on tumor size, tumor type, cellular turnover, tumor location, and disease stage. ctDNA levels are higher in advanced stages of cancer, but the tumor fraction may remain very low even in cases of metastatic disease.

• Study Type: Observational
• Enrollment (Estimated): 300

Contacts and Locations

Study Locations

• France
  • Clamart, France, 94141
    • APHP - Antoine Béclère hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Cases: Pregnant patients with a cancer diagnosis known before pregnancy or discovered during pregnancy.

The comparison data (controls) will be provided in a database that will be compiled progressively by the Cerba laboratory throughout the inclusion period of the case patients.

In this database, data from pregnant patients who underwent a circulating cell-free DNA (cfDNA) test as part of routine care and who were free of any known cancer at the time of sampling for the cfDNA test will be identified.

Description

Inclusion Criteria:

• Inclusion Criteria (Cases):
• Adult patient (≥18 years old);
• Pregnant patient with a cancer known prior to pregnancy or diagnosed during pregnancy;
• Pregnancy at a gestational age > 10 weeks of amenorrhea at the time of inclusion;
• Patient informed and having signed the informed consent form to participate in the study.

Exclusion Criteria:

• Multiple pregnancy;
• Patient with a history of organ transplantation; Patient having received an allogeneic stem cell transplant;
• Known maternal mosaic chromosomal abnormality and copy number variation (CNV);
• Patient presenting with one or more known uterine fibroids at the time of inclusion;
• Technical inability to conduct a teleconsultation via a secure video connection and to complete an electronic signature.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The primary outcome measure is the presence of a chromosomal profile suggestive of a malignant disease (i.e., classification with a moderate or high probability).	"The primary outcome measure is the presence of a chromosomal profile suggestive of a malignant disease (i.e., classification with a moderate or high probability).; Low probability: Chromosomal profile not suggestive of maternal malignant disease (no abnormality* or 1 to 2 abnormalities suggestive of a translocation derivative or an inversion recombinant).; Moderate probability: Chromosomal profile moderately suggestive of maternal malignant disease (2 abnormalities*).; High probability: Chromosomal profile strongly suggestive of maternal malignant disease (3 or more abnormalities*).An abnormality is defined as a trisomy, a monosomy, or a segmental imbalance greater than 7 Mb."	32 months

Secondary Outcome Measures

Outcome Measure	Time Frame
The type of tissue of origin involved in the development of the malignant disease.	32 MONTHS
The stage of cancer development (according to the classification used for each type of cancer considered, e.g., TNM, FIGO, etc.)	32 MONTHS
The results of cytogenetic analyses of solid tumors or bone marrow biopsies that may have been performed during pregnancy	32 MONTHS

Collaborators and Investigators

• Sponsor: Assistance Publique - Hôpitaux de Paris
• Investigators: Principal Investigator: Alexandre VIVANTI, MD, PHD, Antoine Béclère Hospital; Study Chair: MAELIG ABGRAL, MD,MSc, Antoine Béclère Hospital; Study Chair: LISE SELLERET, MD, Tenon Hospital - APHP; Study Chair: Anne-Gael CORDIER, MD,PhD, Tenon Hospital - APHP

Study record dates

Study Major Dates

• Study Start (Estimated): April 15, 2026
• Primary Completion (Estimated): April 15, 2028
• Study Completion (Estimated): November 15, 2028

Study Registration Dates

• First Submitted: February 26, 2026
• First Submitted That Met QC Criteria: February 26, 2026
• First Posted (Actual): March 4, 2026

Study Record Updates

• Last Update Posted (Actual): April 23, 2026
• Last Update Submitted That Met QC Criteria: April 20, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Oncologie; gynécologie
• Additional Relevant MeSH Terms: Neoplasms
• Other Study ID Numbers: APHP240360; 2024-A01203-44 (Other Identifier: Eudract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No