New Therapeutic Options for Breast Cancer during Pregnancy

Self Cite

Breast cancer during pregnancy (BCP) is an important subgroup within the young and very young breast cancer patients. It accounts for about 1% of all breast cancers. Due to an increased awareness, the attitude towards breast cancer during pregnancy has changed and, today, women with BCP are more likely to receive standard chemotherapy and have a term delivery instead of being advised to interrupt the pregnancy or undergo an early preterm delivery. This increased knowledge is based on small cohort studies and international collaborations such as the registry by the German Breast Group for BCP and the initiative of the European Society of Gynaecological Oncology (ESGO). Guidelines and recommendations such as the German guidelines by the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie, www.ago-online.org) and the National Comprehensive Cancer Network (NCCN) guidelines include recommendations for BCP. In general, surgery and chemotherapy (beyond the 13th week of gestation) can be safely performed during pregnancy. Chemotherapy should follow the treatment recommendations for breast cancer in young women. Trastuzumab, endocrine treatment, and radiotherapy are not indicated during pregnancy. Preterm delivery should be avoided as far as possible because it bears a higher risk of infant morbidity and mortality. The treatment of BCP should be planned within a multidisciplinary team including perinatologists, obstetricians and neonatologists.

Section: Systemic Treatmentmentioning

confidence: 99%

Being Pregnant and Diagnosed with Breast Cancer

Loibl

Han²,

Amant³

2012

Self Cite

“…Other drugs, like the pyrimidine-antagonist 5-fluorouracil, should be avoided during pregnancy because of limited experience in pregnancy [10,11,16,17,49]. For other drugs, reports are contradictory, e.g.…”

Section: Fetus · Renal Insufficiency · Trastuzumab · Breast Cancer · mentioning

confidence: 99%

Fetal Renal Insufficiency Following Trastuzumab Treatment for Breast Cancer in Pregnancy: Case Report und Review of the Current Literature

Gottschalk

Berg²,

Harbeck³

et al. 2011

Some drugs are known for their fetal nephrotoxicity and should be avoided during pregnancy. We report on a pregnant woman suffering from breast cancer who received a weekly neoadjuvant trastuzumab (Herceptin®) therapy from 15 weeks of gestation onward, in addition to a 3-weekly carboplatin/docetaxel chemotherapy. Fetal renal insufficiency with anhydramnios and missing visualization of the fetal bladder developed at 21 weeks. After discontinuation of trastuzumab and repeated instillation of amniotic fluid, the amount of amniotic fluid remained stable after 24 weeks of gestation. After caesarean section at 34 weeks because of fetal growth restriction, the renal function of the neonate was normal postnatally. In accordance with the current literature, our case shows a reversible adverse effect of trastuzumab on the fetal renal function and confirms the current recommendation that trastuzumab in pregnancy should be avoided. In pregnancies exposed to trastuzumab, treatment should be discontinued and the fetus should be closely monitored, with particular attention to the amniotic fluid and the fetal bladder volume, as these reflect fetal renal function.

“…Neonatal defects from tamoxifen have been described in the genital tract in female mice. Although tamoxifen has safely been given in patients with metastatic breast cancer without damage to the child, there are other reports of birth defects such as Goldenhar syndrome and ambiguous genitalia in children born to women exposed to tamoxifen [4]. Radiation exposure in the 1st trimester of gestation has been associated with an increased risk of mental retardation and fetal malformation.…”

Section: Introductionmentioning

confidence: 99%

“…Ondansetron has the longest safety record, and no increased frequency of adverse effects has been reported in connection with treating pregnant patients [4].…”

Section: Introductionmentioning

confidence: 99%

Breast Cancer during Pregnancy: An Interdisciplinary Approach in Our Institution

Pîrvulescu

Mau²,

Schultz³

et al. 2012

Background: Breast cancer is the most common cancer diagnosed during pregnancy. Case Report: We report on a case of a 26-year-old woman who was diagnosed with right-sided breast cancer in her 15th week of gestation. We discussed possible treatment scenarios and the patient opted for neoadjuvant therapy with taxanes and anthracyclines during pregnancy, followed by delivery and then followed by surgery, antibody therapy, and radiotherapy. The patient received neoadjuvant chemotherapy with paclitaxel 80 mg/m² weekly for 12 cycles, followed by 4 cycles of epirubicin and cyclophosphamide (90/600 mg/m²) every 3 weeks. Complete clinical response was seen after preoperative chemotherapy. After delivery of a healthy child at 40 weeks of gestation, she received breast-conserving surgery and axillary dissection. Anti-HER2 antibody treatment with trastuzumab was started concomitantly with adjuvant radiotherapy. Endocrine treatment with a gonadotropin-releasing hormone (GnRH) analog and tamoxifen for 5 years was planned to be started after radiotherapy. Conclusion: Treatment of breast cancer during pregnancy requires an interdisciplinary approach and careful consideration of the patient’s stage of disease, the gestational age, and the preferences of the patient and her family.