Breast cancer during pregnancy: epidemiology, phenotypes, presentation during pregnancy and therapeutic modalities

Boere, Ingrid; Lok, Christianne; Poortmans, Philip; Koppert, Linetta B.; Painter, Rebecca C.; Heuvel-Eibrink, Marry M. vd; Amant, Frédéric

doi:10.1016/j.bpobgyn.2022.05.001

Cited by 33 publications

(47 citation statements)

References 54 publications

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“…The flowchart of searching strategy and study selection is shown in Table 1. Forty‐seven articles were strongly in favour of performing SLNB in PrBC, 2,4,6,13–56 4 articles were partially in favour, 57–60 2 articles were partially against 61,62 and 10 articles were strongly against SLNB in PrBC patients 3,5,10,63–69 . Sub‐analysis based on type of study showed that out of 47 articles which were strongly in favour of SLNB, 11 were prospective cohorts or RCTs, 5 were retrospective case series or case reports, 25 were review articles and 6 articles were guidelines.…”

Section: Resultsmentioning

confidence: 99%

Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update

Bothou,

Margioula‐Siarkou,

Petousis

et al. 2023

Eur J Clin Investigation

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BackgroundPregnant patients diagnosed with breast cancer (PrBC) may receive substantially different treatments compared to general population, considering that certain treatment options cannot be applied during pregnancy due to their potential harmful effects to the foetus. Regarding the use of sentinel lymph node biopsy (SLNB) in pregnant patients, potential concerns include foetal harm from radiation exposure, possible teratogenic effects of blue dyes and maternal anaphylaxis to isosulfan.ObjectiveThe main objective of the present systematic review is to summarize and present current knowledge and up‐to‐date evidence about the safety and efficacy of SLNB in PABC.MethodsMEDLINE, Google Scholar and UpToDate databases were searched up to 22 January 2023. Articles studying the safety and effectiveness of SLNB in patients for PrBC were eligible for inclusion in the present review.ResultsIn total, 63 articles that met the inclusion criteria were included in this study. Forty‐seven articles were strongly in favour of performing SLNB in PABC, 4 articles were partially in favour, 10 articles were strongly against and 2 articles were partially against performing SLNB in PABC. Sub‐categorization based on type of study showed that the majority of studies in favour were of higher level of evidence than those against. Furthermore, there were overall 12 studies reporting on outcomes. There were overall 382 women with PrBC that underwent SLNB. Full data were reported for 237 cases. Overall live birth rate was 95.8%, while overall neonatal complication rate was 3.4%.No case of maternal side effects or anaphylactic reaction, maternal death, stillbirth and neonatal death was reported (0%).ConclusionsSentinel lymph node biopsy seems to be safe and effective technique for breast cancer during pregnancy.

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Section: Resultsmentioning

confidence: 99%

Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update

Bothou,

Margioula‐Siarkou,

Petousis

et al. 2023

Eur J Clin Investigation

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“…Thus, examinations with greater radiation, such as tomography, scintigraphy and PET-Scan, should be replaced by those that do not expose the fetus to radiation, such as abdominal ultrasound and spinal magnetic resonance, the latter used only if the patient complains of back pain. Chest X-ray is also safe in the investigation of metastases during pregnancy, because despite using ionizing radiation, it has low levels, so it is not harmful to the fetus if used with caution 11 .…”

Section: Discussionmentioning

confidence: 99%

Invasive ductal carcinoma of the breast in a pregnant woman: case report

2022

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Gestational breast cancer is the most common cause of cancer in pregnant women. It is a challenging condition for the medical team, since the physiological changes in the breast during this period increase the density of the breast parenchyma, which makes it difficult to detect the nodule on physical and imaging examination, causing delay in diagnosis. We present here a case report of a woman with breast cancer diagnosed during pregnancy. This was a 28-year-old female patient who arrived at the service at 14 weeks’ gestation, diagnosed with invasive ductal carcinoma in the left breast, with T4dN2M0 staging. Neoadjuvant chemotherapy treatment was started with a pause for the cesarean section at 36 weeks’ gestation. After delivery, chemotherapy was restarted, followed by radical mastectomy, radiotherapy and hormone therapy. Two years after the initial diagnosis and still being treated with hormone therapy, the patient presented with musculoskeletal pain, detected on magnetic resonance imaging and bone scintigraphy, as well as several points of metastasis in the spine with pathological fracture of L2-L3, where she was then submitted to decompressive laminectomy. After surgery, radiotherapy of the thoracic and lumbar spine was started, in addition to chemotherapy. Currently, the patient is asymptomatic, being on paclitaxel and transtuzumab, with stable bone scintigraphy and radiography and ultrasound showing no metastases, and the child is healthy after three years of follow-up.

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“…After diagnosis, treatment can be given postpartum if the patient is in near term; otherwise, treatment should not be postponed until after the termination of pregnancy [ 118 ]. Breast cancer surgery may be performed safely during any stage of pregnancy with sentinel lymph node staging, favoring breast-conserving surgery when feasible, while radiotherapy may start after delivery [ 119 ]. Regarding systemic therapy, in PABC, the same guidelines as in non-pregnant patients should be followed.…”

Section: Early Tnbc and Chemoimmunotherapy: Implications For Pregnanc...mentioning

confidence: 99%

“…Regarding systemic therapy, in PABC, the same guidelines as in non-pregnant patients should be followed. Chemotherapy, including anthracyclines, fluoropyrimidines, taxanes, and platinum agents, is feasible after the first trimester, and it can be carried out in both neoadjuvant and adjuvant settings, taking into account the gestational age and overall treatment plan, including need of HER2 targeted therapy (contraindicated in pregnancy), and indication for radiotherapy [ 119 ]. Regarding the possible reproductive ICIs toxicity, the PD-1/PD-L1 axis is critical in maintaining maternal fetal immunotolerance.…”

Section: Early Tnbc and Chemoimmunotherapy: Implications For Pregnanc...mentioning

confidence: 99%

Updated Neoadjuvant Treatment Landscape for Early Triple Negative Breast Cancer: Immunotherapy, Potential Predictive Biomarkers, and Novel Agents

Garufi

Carbognin

Schettini

et al. 2022

Cancers

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Triple-negative breast cancer (TNBC) is characterized by the absence of hormone receptor and HER2 expression, and therefore a lack of therapeutic targets. Anthracyclines and taxane-based neoadjuvant chemotherapy have historically been the cornerstone of treatment of early TNBC. However, genomic and transcriptomic analyses have suggested that TNBCs include various subtypes, characterized by peculiar genomic drivers and potential therapeutic targets. Therefore, several efforts have been made to expand the therapeutic landscape of early TNBC, leading to the introduction of platinum and immunomodulatory agents into the neoadjuvant setting. This review provides a comprehensive overview of the currently available evidence regarding platinum agents and immune-checkpoint-inhibitors for the neoadjuvant treatment of TNBC, as well as the novel target therapies that are currently being evaluated in this setting. Taking into account the economic issues and the side effects of the expanding therapeutic options, we focus on the potential efficacy biomarkers of the emerging therapies, in order to select the best therapeutic strategy for each specific patient.

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Breast cancer during pregnancy: epidemiology, phenotypes, presentation during pregnancy and therapeutic modalities

Cited by 33 publications

References 54 publications

Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update

Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update

Invasive ductal carcinoma of the breast in a pregnant woman: case report

Updated Neoadjuvant Treatment Landscape for Early Triple Negative Breast Cancer: Immunotherapy, Potential Predictive Biomarkers, and Novel Agents

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