Exploring the safety of chemotherapy for treating breast cancer during pregnancy

Lambertini, Matteo; Kamal, Nermine Shawky; Peccatori, Fedro Alessandro; Mastro, Lucia Del; Azim, Hatem Hamdy Abdel

doi:10.1517/14740338.2015.1061500

Cited by 19 publications

(27 citation statements)

References 71 publications

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“…Experts argue that women can and should be reassured that the drugs used to treat GBC do not adversely affect the foetus if they are administered in the second and third trimesters and that treatment should not be delayed (Amant et al, 2015;Lambertini et al, 2015). All participants expressed considerable worry about the effects of treatment on the health of the foetus.…”

Section: The Bodymentioning

confidence: 99%

Health care experiences among women diagnosed with gestational breast cancer

et al. 2017

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Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi-structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were "communication" and "comprehensive care." "Communication" had two sub themes: "interdisciplinary communication" (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and "patient communication" (how they communicated this to the woman). The "comprehensive care" theme incorporated three sub themes: "the spirit" (psychological care); "the mind" (information provision); and "the body" (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care; offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised; and inform the development of resources to assist women and their families.

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Section: The Bodymentioning

confidence: 99%

Health care experiences among women diagnosed with gestational breast cancer

et al. 2017

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“…As with any medical condition in pregnancy, it is important to evaluate the perinatal effects of breast cancer for both mother and fetus. A few such studies have been conducted but they were small in size and heterogeneous in nature . The purpose of our study is to evaluate the incidence of PABC and the effect of breast cancer in pregnancy on the fetus using a large population‐based cohort of women delivering in the United States.…”

Section: Introductionmentioning

confidence: 99%

Neonatal outcomes of pregnancy‐associated breast cancer: Population‐based study on 11 million births

et al. 2019

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Background As the age at first pregnancy continues to rise in the United States so does the incidence of breast cancer diagnosed during pregnancy. Our objective was to evaluate temporal trends in the incidence of pregnancy‐associated breast cancer (PABC) and to measure neonatal outcomes associated with PABC. Methods We conducted a population‐based cohort study using the 1999‐2012 Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP‐NIS) from the United States. Logistic regression models, adjusted for maternal baseline characteristics, examined the effect of PABC on neonatal outcomes. Results There were 11 846 300 deliveries between 1999 and 2012, of which 772 cases of PABC were identified, resulting in an overall incidence of 6.5 cases/100 000 pregnancies. There was a significant increase in the incidence of PABC during the study period (P < 0.05). Women with PABC tended to be older, of white ethnicity, belong to a higher income quartile and to be treated in an urban teaching hospital. In pregnancies complicated by breast cancer, there was a greater risk of preterm delivery (OR 4.84, 95% CI 4.05‐5.79) and preterm premature rupture of membranes (OR 1.79, 95% CI 1.06‐3.05). No associations were observed between PABC and intrauterine growth restriction, congenital anomalies or intrauterine fetal demise. Conclusion There is an uptrend in the incidence of PABC and therefore, the need for counseling these patients is also increasing. Although pregnancies with the diagnosis of maternal breast cancer are more prone to premature births, it is encouraging that these babies do not appear to be at increased risk for congenital anomalies, growth restriction, or fetal demise.

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“…Lambertini, et al concluded that there is usually enough time to use a multidisciplinary approach regardless of the gestational age at which diagnosis is made. However, despite the amount of data on chemotherapy use during pregnancy, the review noted that treatment recommendations of these women rely on limited evidence and that there were no specific guidelines for monitoring individuals with prenatal exposure to agents [1,[9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Adriamycin and cyclophosphamide are generally well tolerated in pregnancy and suggested to be two of the chemotherapy drugs of choice for treatment of PABC in a recent expert opinion published by Lambertini, et al in which he reviews the literature to date which is admittedly limited of the safety profile of these drugs during pregnancy. The most common medical side effect of these drugs is myelosuppression in both the mother and fetus [3,5,7,9,12,13]. In one study, Rouzier demonstrated the chemosensitivity to these drugs was the same in tumors of PABC and tumors of non-pregnancy associated breast cancers [3,14].…”

Section: Discussionmentioning

confidence: 99%

“…It appears to be correlated with a higher incidence of oligohydramnios during pregnancy which can predispose to preterm labor and therefore increase fetal morbidity and mortality. Similarly, tamoxifen also increases the risk to the fetus specifically through anatomic defects including craniofacial malformations and ambiguous genitalia [9,11,12]. For these reasons, our patient was not given these classes of medications until after delivery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Importance of a Multidisciplinary Approach to Breast Cancer Treatment in Pregnancy: Case Report of New Diagnosis of Pregnancy-Associated Breast Cancer

Grant¹,

DiCarlo²,

Woessner-Hoyson³

2016

J Carcinog Mutagen

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Pregnancy-Associated Breast Cancer (PABC) is a rare diagnosis and includes new diagnoses of cancer both during pregnancy as well as within the first year post-delivery. Due to its rarity, there is of yet no gold standard treatment nor is there a standardized regimen of treatment during pregnancy according to the American College of Obstetrics and Gynecology (ACOG). We report a case involving a 35-year-old gravida 2 para 1-0-0-1 who was diagnosed with clinical stage II (T2 N1) breast cancer in the early third trimester of pregnancy after physical examination revealed a palpable mass. Ultrasound-guided biopsy revealed poorly differentiated infiltrating ductal carcinoma, nuclear grade 3, with micropapillary features, estrogen receptor (ER 90%), progesterone receptor (PR 25%) positive, HER2 positive 3+ with Ki67 index 75%. After extensive counseling and discussion between Obstetrics, Maternal Fetal Medicine, Breast Surgery, Neonatal ICU, and Oncology, a decision was made to initiate neoadjuvant chemotherapy (NAC) with adriamycin and cyclophosphamide. Our patient completed 4 total NAC treatments prior to delivery followed by a regimen of weekly taxol plus herceptin and perjeta postpartum. This patient strongly desired to carry the pregnancy to term and began treatment prior to delivery, making this case unique in comparison to other publications in which treatment was delayed until after delivery, or the pregnancy was terminated prior to beginning treatment. Our case highlights the importance of a multi-disciplinary approach to counseling patients in this unique situation to allow them the autonomy to choose the treatment best for them and their baby.

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Exploring the safety of chemotherapy for treating breast cancer during pregnancy

Cited by 19 publications

References 71 publications

Health care experiences among women diagnosed with gestational breast cancer

Health care experiences among women diagnosed with gestational breast cancer

Neonatal outcomes of pregnancy‐associated breast cancer: Population‐based study on 11 million births

Importance of a Multidisciplinary Approach to Breast Cancer Treatment in Pregnancy: Case Report of New Diagnosis of Pregnancy-Associated Breast Cancer

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