ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC)

Loibl, Sibylle; Azim, Hatem A.; Bachelot, Thomas; Berveiller, Paul; Bosch, Ana; Cardonick, Elyce; Denkert, Carsten; Halaška, Michael; Hoeltzenbein, Maria; Johansson, Anna L.V.; Maggen, Charlotte; Markert, Udo R.; Peccatori, Fedro Alessandro; Poortmans, Philip; Saloustros, Emmanouil; Saura, Cristina; Schmid, Peter; Stamatakis, Emmanouil; Heuvel‐Eibrink, Marry van den; Gerwen, Mathilde van; Vandecaveye, Vincent; Pentheroudakis, George; Curigliano, Giuseppe; Amant, Frédéric

doi:10.1016/j.annonc.2023.08.001

Cited by 18 publications

(11 citation statements)

References 129 publications

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“…Breast cancer tends to be in a more advanced stage of disease in these women compared to non-pregnant women 50 , 51 , 52 , 53 and is an interdisciplinary challege. The Expert Consensus Statements of the ESMO (European Society for Medical Oncology) 55 and the International Advisory Board of Cancer in Pregnancy ( ) are relevant in this context.…”

Section: Other Topicsmentioning

confidence: 99%

Update Breast Cancer 2024 Part 1 – Expert Opinion on Advanced Breast Cancer

Würstlein,

Kolberg,

Hartkopf

et al. 2024

Geburtshilfe Frauenheilkd

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Clinical evidence is interpreted based on clinical studies and personal experience which can lead to different interpretations of data. This makes the opinions issued by panels of experts such as the Advanced Breast Cancer Panel which convened in November 2023 for the seventh time (ABC7) particularly important. At the conference, current issues around advanced breast cancer were evaluated by an international team of experts.In 2023 the data on CDK4/6 inhibitors was so extensive that the answers to questions about the sequencing of therapy and the potential use of chemotherapy as an alternative therapy were relatively clear. Moreover, data on antibody drug conjugates which provides a good overview of their uses is available for all molecular subtypes.Some therapeutic settings, including patients with brain metastases or leptomeningeal disease, older patients, locally advanced breast cancer and visceral crises, continue to be particularly important and were discussed in structured sessions. The scientific context of some of the topics discussed at ABC7 is presented and assessed here.

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Section: Other Topicsmentioning

confidence: 99%

Update Breast Cancer 2024 Part 1 – Expert Opinion on Advanced Breast Cancer

Würstlein,

Kolberg,

Hartkopf

et al. 2024

Geburtshilfe Frauenheilkd

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“…Optimal treatment of PrBC should be multimodal and follow the well‐established approach to non‐pregnant patients with BC. 10 However, consideration should be given to the fetus's welfare when deciding on the type of surgery. Mastectomy may be chosen in cases where adjuvant chemotherapy will likely not be appropriate, in an effort to eliminate the need for adjuvant radiotherapy.…”

Section: Treatment Approach To Pregnancy‐related Breast Cancermentioning

confidence: 99%

“… 11 In highly selected cases when postponing radiotherapy until after delivery is deemed detrimental to prognosis, radiation can be delivered during the first and part of the second trimester following careful consideration of gestational age, shielding, required dose, and fractionation. 10 In this context, proton radiotherapy is a recent development that allows considerable reduction in fetal exposure, although standardization is needed. 12 …”

Section: Treatment Approach To Pregnancy‐related Breast Cancermentioning

confidence: 99%

“… 14 Evidence on immune checkpoint inhibitors during pregnancy is limited, but consensus guidelines recommend avoiding their use during neoadjuvant treatment of triple‐negative PrBC. 10 This recommendation is based both on biologic rationale, given the role of programed cell death protein 1 (PD‐1) / programed death ligand 1 (PD‐L1) axis in maternal immune tolerance against the fetus, 15 and small case series that have shown increased incidence of pregnancy complications. 16 , 17 Finally, cyclin‐dependent kinase 4/6 inhibitors (CDK4/6i) and poly (ADP‐ribose) polymerase inhibitors should be avoided during pregnancy both because of the need for concomitant endocrine therapy in the case of CDK4/6i, and because of animal studies showing fetal harm following exposure.…”

Section: Treatment Approach To Pregnancy‐related Breast Cancermentioning

confidence: 99%

“…Therefore, instead of evidence‐based guidelines, management of PrBC is guided by expert consensus statements such as one recently published by the European Society for Medical Oncology. 10 …”

Section: Introduction and Diagnosismentioning

confidence: 99%

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Breast cancer during pregnancy—The oncologist's point of view

Matikas,

Bergh

2023

Acta Obstet Gynecol Scand

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Breast cancer is the most common malignancy diagnosed during or directly after pregnancy. Differences in pathogenesis and prognosis identify two distinct patient groups, those with breast cancer during pregnancy and those with postpartum breast cancer which, for reasons not completely understood, is associated with worse outcomes. Compared with breast cancer in the non‐pregnant patient, several limitations in terms of both local and systemic therapy are applied to limit fetal harm. Treatment is nevertheless delivered with curative intent, therefore avoiding harmful delays in therapy initiation, unnecessary therapy de‐escalation or chemotherapy dose modifications is strongly recommended. In this short commentary, we briefly review current evidence and treatment guidelines and provide recommendations for optimal oncologic management of pregnancy‐related breast cancer.

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Outcomes of patients treated with chemotherapy for breast cancer during pregnancy compared with nonpregnant breast cancer patients treated with systemic therapy

Johnson,

Song,

Warneke

et al. 2024

Cancer

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IntroductionPrior studies of patients treated for breast cancer during pregnancy (PrBC) report mixed outcomes and are limited by substandard treatment, small cohorts, and short follow‐up. This study compared survival outcomes of PrBC patients treated with chemotherapy during pregnancy with nonpregnant patients matched by age, year of diagnosis, stage, and subtype.MethodsPrBC patients treated from 1989 to 2022 on prospective institutional protocols were eligible. Disease‐free survival (DFS), overall survival (OS), and progression‐free survival (PFS) were estimated using the Kaplan–Meier method and multivariable Cox proportional hazards regression.ResultsAmong 143 PrBC and 285 nonpregnant patients, median follow‐up was 11.4 years. Survival differences were statistically significant, with median DFS and OS not attained for PrBC patients versus 5.6 years (95% confidence interval [CI], 3.6–15.4; p = .0001) and 19.3 years (95% CI, 14.1–not estimated; p = .0262) for nonpregnant patients, respectively. Median PFS was 24.1 years (95% CI, 15.8–not estimated) for PrBC patients versus 8.4 years (95% CI, 6.4–10.9) for the nonpregnant cohort (p = .0008). Study cohort was associated with DFS, PFS, and OS in multivariable analyses, with the nonpregnant cohort having increased risks of disease recurrence (hazard ratio [HR], 1.91; 95% CI, 1.33–2.76; p = .0005) and disease progression or death (HR, 1.68; 95% CI, 1.19–2.39; p = .0035), and shorter OS (HR, 1.52; 95% CI, 1.01–2.29; p = .0442).ConclusionThese data suggest that PrBC patients treated with chemotherapy during pregnancy have at least comparable, if not superior, outcomes than nonpregnant patients with similar age, cancer stage, and subtype. Analyses excluding patients with postpartum breast cancer were unable to be performed and are a priority for future confirmatory studies.

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ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC)

Cited by 18 publications

References 129 publications

Update Breast Cancer 2024 Part 1 – Expert Opinion on Advanced Breast Cancer

Update Breast Cancer 2024 Part 1 – Expert Opinion on Advanced Breast Cancer

Breast cancer during pregnancy—The oncologist's point of view

Outcomes of patients treated with chemotherapy for breast cancer during pregnancy compared with nonpregnant breast cancer patients treated with systemic therapy

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