Herceptin therapy in pregnancy: Continuation of pregnancy in the presence of anhydramnios

Warraich, Q; Smith, Norman C.

doi:10.1080/01443610802643774

Cited by 22 publications

(21 citation statements)

References 4 publications

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“…In seven of the related cases (including the present), TTZ was used for 25 weeks or more (roughly equivalent to two gestational trimesters). Three of the four reported neonatal deaths occurred in the group that received TTZ for the longest period [3,12,13].…”

Section: Discussionmentioning

confidence: 99%

Trastuzumab use during pregnancy

et al. 2016

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Here, we describe the case of a patient diagnosed with locally advanced breast cancer 8 years ago. Her treatment course was neoadjuvant chemotherapy, followed by mastectomy and then adjuvant radiotherapy and trastuzumab (TTZ). During the use of adjuvant targeted therapy, an incidental pregnancy was diagnosed. Four years later, she developed bone and cerebral metastases, and since then, she has received courses of TTZ, capecitabine, lapatinib, and radiotherapy with intermittent control of the disease. Her 7-year-old son presents a normal physical and long-term neurological developmental curve according to specialized evaluation. This case is unique for several reasons: the patient received the highest dose of TTZ yet described during pregnancy (4400 mg); there has been a long period of disease-free survival after treatment for locally advanced breast cancer and long overall survival despite successive disease progressions during the metastatic phase of the disease (97 months), and there was a monitored pediatric follow-up period (7 years).

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Section: Discussionmentioning

confidence: 99%

Trastuzumab use during pregnancy

et al. 2016

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“…Probably the reduction of amniotic fluid can be reversed by interrupting the trastuzumab therapy, as we observed in our case. [6,7]. In einem Fall einer Zwillings schwangerschaft ist interessanterweise nur ein Kind von chroni scher Nieren-und Lungeninsuffizienz betroffen, während das andere Kind sich nach intensiv pädiatrischer Therapie mit kurz fristiger CPAP-Beatmung und vorübergehender Retentionswer terhöhung normal entwickeln konnte [8].…”

Section: Abstract ▼unclassified

Fallbericht einer Trastuzumab-Therapie während der Schwangerschaft bei metastasiertem Mammakarzinom

Rasenack

Gaupp

Rautenberg

et al. 2016

Z Geburtshilfe Neonatol

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The increasing number of pregnant breast cancer patients calls for a therapy that is as efficient as possible. After 10 years of collecting data on pregnant breast cancer patients in the German Breast Group (GBG), proposals for diagnostic measures and therapy regarding this special situation have been developed on the basis of 500 observed cases. Chemotherapy is regarded as safe from the 14(th) week of gestation on, but it is strongly advised not to use trastuzumab. Adverse outcomes for the newborn were predominantly observed in cases of early preterms. In our department, a 29-year-old second gravida with metastatic breast cancer first diagnosed 7 years ago continued to receive trastuzumab treatment at her express request after detailed information and advice. Trastuzumab treatment had been started 1.5 years before the pregnancy after surgical removal of a lymph node metastasis. After 7 intravenous administrations at intervals of 3 weeks, an oligohydramnios occurred in the 24(th) week of pregnancy. For this reason, trastuzumab treatment was interrupted for 7 weeks, during which time the quantity of amniotic fluid returned to a normal level. As the 8(th) administration of trastuzumab led to a renewed oligohydramnios, the trastuzumab treatment was suspended until birth. The quantity of amniotic fluid having recovered to normal, labour was induced after 36 weeks of pregnancy, followed by a Caesarian section because of prolonged labour. The newborn boy showed no sign of respiratory or renal dysfunction and has developed normally, having at present reached the age of 3 years. From the few reported cases of pregnancies with trastuzumab therapy, it seems that an occurring oligohydramnios is the typical complication with the problem of life-threatening RDS after birth. Probably the reduction of amniotic fluid can be reversed by interrupting the trastuzumab therapy, as we observed in our case.

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“…It is also possible that inhibition of the vascular Therapeutic Advances in Medical Oncology 3 (2) endothelial growth factor (VEGF) may occur, which regulates the production and re-absorption of the amniotic fluid [Pant et al 2008]. Four neonatal deaths were reported after exposure to trastuzumab in utero, secondary to respiratory and renal failure [Beale et al 2009;Warraich and Smith, 2009;Witzel et al 2008;Weber-Schoendorfer and Schaefer, 2008]. Three other neonates developed transient respiratory and/or renal failure but this proved reversible [Beale et al 2009;Bader et al 2007;Shrim et al 2007].…”

Section: Targeted Therapiesmentioning

confidence: 99%

Chemotherapy for breast cancer in pregnancy: evidence and guidance for oncologists

McGrath

Ring

2010

Ther Adv Med Oncol

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It has been estimated that up to 3.8% of breast cancers may be diagnosed in women who are pregnant, with an estimated 1 in 3000-3500 deliveries occurring in women with breast cancer. Owing to the lack of large randomized trials available to guide our clinical practice, our decisions regarding adjuvant systemic management are based on retrospective analyses, case reports and a small number of prospective studies. A tailored approach to treatment is required with careful consideration given at all stages to the needs of the mother and risks to the foetus. Management is critically influenced by the stage of pregnancy, especially the first trimester. Anthracycline-based chemotherapy may be administered during the second and third trimesters, with apparently few short-term implications. Limited data shows the taxanes may also be given with few adverse events at these stages. Weekly fractionation regimens may allow closer monitoring of pregnancy with prompt termination of agents, if necessary. Data concerning the long-term risks of systemic anticancer treatment are limited. All stages of patient management should be discussed within a multidisciplinary team and a clear consensus of treatment options communicated to the mother. Delaying chemotherapy until after delivery may be reasonable in some cases, but where the delay is likely to be prolonged, a decision must be made on the basis of risks versus benefits.

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Herceptin therapy in pregnancy: Continuation of pregnancy in the presence of anhydramnios

Cited by 22 publications

References 4 publications

Trastuzumab use during pregnancy

Trastuzumab use during pregnancy

Fallbericht einer Trastuzumab-Therapie während der Schwangerschaft bei metastasiertem Mammakarzinom

Chemotherapy for breast cancer in pregnancy: evidence and guidance for oncologists

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