Neonatal Effects of Breast Cancer Chemotherapy Administered During Pregnancy

Kerr, Julia R.

doi:10.1592/phco.25.3.438.59291

Cited by 5 publications

(7 citation statements)

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“…One child had Down's syndrome and two had congenital abnormalities (club foot, congenital bilateral ureteral reflux) (17). A retrospective study described similar results in 28 patients treated with chemotherapy in the period after the first trimester of pregnancy (18), whereas a study with 40 patients treated with antracyclines or cyclophosphamide after the first trimester reported no neonatal or maternal complications (19). Thus far, not enough evidence has been accumulated on taxane use in pregnancy though fetal toxicity has been noted in animal models.…”

Section: Discussionmentioning

confidence: 91%

Presentation, Management and Outcome of 32 Patients with Pregnancy-Associated Breast Cancer: A Matched Controlled Study

et al. 2009

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Pregnancy-associated breast cancer (PABC) is a rare and challenging problem. We sought to describe epidemiology, management and outcome of women in whom breast cancer was diagnosed during pregnancy or within one year after delivery. Thirty-two women with PABC were referred to two European Union oncology centers between 1995 and 2007, 16 during pregnancy and 16 within 1 year after delivery. Data concerning diagnosis, management, delivery and fetal and maternal outcome were recorded. A group of 32 patients (matched controls) presenting with nonpregnancy-associated breast cancer (non-PABC) was matched for age at diagnosis, tumor size and stage to each PABC patient. Differences in outcome between the PABC and non-PABC groups were then assessed. Histological features were similar in both groups, except that estrogen receptor-negative tumors were more common in the PABC group. Three patients received chemotherapy and two others underwent surgery during pregnancy, with no excess toxicity or severe maternal/fetal adverse effects. All children in the PABC group were healthy, except for one exposed to epirubicin in utero and born with rectal atresia. Overall survival was similar in PABC and non-PABC patients (p = 0.449). The subgroup of patients with breast cancer diagnosed within one year after delivery showed a shorter time to relapse than controls or patients with gestational cancer (p = 0.0178). PABC is a special situation, necessitating individualized, multi-disciplinary management. Prognosis is similar for women with nongestational cancer matched for age and stage though poorer outcome postpartum should be further investigated.

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Section: Discussionmentioning

confidence: 91%

Presentation, Management and Outcome of 32 Patients with Pregnancy-Associated Breast Cancer: A Matched Controlled Study

et al. 2009

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“…Exposure to chemotherapy drugs during the 1st trimester is associated with increased risk of spontaneous abortion, fetal death, and major malformations [5][6][7], whereas chemotherapy during the 2nd and 3rd trimesters of pregnancy has been associated with intrauterine growth restriction and low birth weight [6]. In utero myelosuppression by chemotherapy exposure has been implicated in neutropenia and anemia in the newborn period [8]. Maternal risks of chemotherapy during pregnancy include consequences of myelosuppression such as neutropenia and generalized immunosuppression, risk of infection, anemia, and excessive hemorrhage during delivery [1].…”

Section: Introductionmentioning

confidence: 99%

Effects of Chemotherapy during Pregnancy on the Placenta

Abellar

Pepperell

Greco³

et al. 2009

Pediatr Dev Pathol

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Whereas the effects of chemotherapy during pregnancy for mother and fetus are well described, its effects on the placenta remain largely undetermined. We performed a retrospective clinicopathologic analysis of the placenta following chemotherapy. Charts were reviewed for type of malignancy, type and timing of chemotherapy, and fetal and pregnancy outcome. Placentas were studied by standard pathologic analysis as well as computer-assisted morphometry and fluorescence in situ hybridization (FISH) analysis. Patients (n = 13) underwent chemotherapy during pregnancy for carcinoma of breast (3), ovary (2), cervix (2), salivary gland (1), lymphoma/leukemia (4), or rhabdomyosarcoma (1). Eleven patients were treated with DNA-active cytotoxic agents during the 2nd and/or 3rd trimesters; their placentas showed nonspecific findings, including villous hypermaturity, distal villous hypoplasia, villous edema, and excessive extravillous trophoblast, and 4/11 (36%) were small-for-age. In one case (rhabdomyosarcoma), the mother was exposed to cytotoxic agents throughout the entire pregnancy. In this case, associated with severe congenital anomalies, the placenta showed striking nuclear pleomorphism of the extravillous trophoblast of the chorion laeve, associated with FISH-demonstrated hyperpolyploidy. One patient was treated with the targeted tyrosine kinase inhibitor, imatinib, in 2 consecutive pregnancies; these placentas showed no specific anomalies. Our findings suggest that chemotherapy during the 1st trimester induces excessive polyploidization of the chorion laeve trophoblast, likely representing an adaptive response to intraamniotic toxins. Second and 3rd trimester exposure to cytotoxic agents may predispose to placental underdevelopment. However, without appropriate controls (untreated patients with equivalent malignancies), the specific effects of chemotherapy in this group are difficult to assess.

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“…Potential damage to the fetus is a major concern because of the teratogenic effects of antimetabolites, alkylating agents, and radiation therapy (Beckman & Brent, 1986;Sachs et al, 1990). A human fetus is most susceptible to teratogenic agents during the first trimester of pregnancy (Kerr, 2005). However, chemotherapy can be safe to women during the second and third trimesters of pregnancy (Ring et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…, 1990). A human fetus is most susceptible to teratogenic agents during the first trimester of pregnancy (Kerr, 2005). However, chemotherapy can be safe to women during the second and third trimesters of pregnancy (Ring et al.…”

Section: Introductionmentioning

confidence: 99%

Hematological malignancy and pregnancy: a single-institution experience of 21 cases

et al. 2006

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The incidence of hematological malignancies during pregnancy is low, and treatment in this setting is problematic. This study observed 21 pregnancies in 18 patients with hematological malignancies. Patients' ages were between 19 and 43 (median 25) years. Two pregnancies ended with spontaneous abortion, one pregnancy ended with in utero death, three therapeutic abortions were carried out, and 15 infants were born alive but three of them died later. The median birth weight was 2.47 kg. Twelve babies survived to a median age of 36 (range 4-117) months. Eight babies were exposed to chemotherapy during the in utero period. One baby was exposed to chemotherapy during all the trimesters and was born prematurely and later died because of intracranial bleeding. Four babies were exposed to chemotherapy during the first trimester, one of them had low birth weight and floating thumb malformation, two of them had only low birth weight, and one was born healthy, but died at 3 months of age as a result of severe gastroenteritis. Two babies were exposed to chemotherapy during the second and third trimesters; one of them had low birth weight, and the other pregnancy ended in in utero death. One infant was exposed to chemotherapy during the third trimester and was born at term, but died because of pulmonary hemorrhage. We concluded that chemotherapy during all trimesters of pregnancy carries a significant risk for an unfavorable outcome.

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Neonatal Effects of Breast Cancer Chemotherapy Administered During Pregnancy

Cited by 5 publications

References 0 publications

Presentation, Management and Outcome of 32 Patients with Pregnancy-Associated Breast Cancer: A Matched Controlled Study

Presentation, Management and Outcome of 32 Patients with Pregnancy-Associated Breast Cancer: A Matched Controlled Study

Effects of Chemotherapy during Pregnancy on the Placenta

Hematological malignancy and pregnancy: a single-institution experience of 21 cases

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