Update on the Management of Breast Cancer during Pregnancy

Poggio, F.; Tagliamento, Marco; Pirrone, Chiara; Soldato, Davide; Conte, Benedetta; Molinelli, Chiara; Cosso, Maurizio; Fregatti, Piero; Mastro, Lucia Del; Lambertini, Matteo

doi:10.3390/cancers12123616

Cited by 46 publications

(50 citation statements)

References 86 publications

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“…Overall, 487 articles were identified and screened. After removal of 471 irrelevant articles, 9 reviews 10 , 11 , 12 , 23 , 24 , 25 , 26 , 27 , 28 and 3 non-English articles, 13 , 14 , 15 4 studies were considered eligible for our review. 29 , 30 , 31 , 32 Having investigated the references of the relevant reviews and eligible articles, two more articles were added.…”

Section: Resultsmentioning

confidence: 99%

Immune checkpoint inhibitor administration during pregnancy: a case series

et al. 2021

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Background: Immune checkpoint inhibitors have been widely implemented in current clinical practice. Although cancer occurs in w1 out of 1000 pregnancies, treatment remains challenging. Until now, limited data exist regarding immunotherapy administration during pregnancy. This systemic review aims to synthesize all available data from immunotherapy administration in pregnant women and evaluate the efficacy and safety of immunotherapy during pregnancy. Patients and methods: Eligible studies were identified by a search of the PubMed Medline database and Food and Drug Administration Adverse Events Reporting System Public Dashboard for the period 1 January 2000 to 1 April 2021; the algorithm consisted of a predefined combination of the words 'immunotherapy', 'cancer' and 'pregnancy'. PRISMA guidelines were applied in this study. Results: Overall, seven articles (seven pregnancies, nine neonates) were retrieved. The mean duration of immunotherapy administration was 9.8 weeks [standard deviation (SD): 11.27; median: 7.0; range: 1-32]. In all cases specified, melanoma was the malignancy reported. The mean gestational age at delivery was 30.4 weeks (SD: 5.03; median: 32.0; range: 24-38), whereas the mean weight of neonates at delivery was 1267 g (SD: 412.0; median: 1400; range: 590-1701). Only one neonate was born term at 38 weeks of pregnancy (11.1%; 1/9). Complications during pregnancy were observed in 71.4% of cases: intrauterine growth restriction (three cases), HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) (one case), placental insufficiency (one case) and low fetal heart rate (one case). The mean progression-free survival and overall survival were 16.0 and 25.2 months, respectively. Conclusion:The administration of immune checkpoint inhibitors during pregnancy is associated with increased incidence of pregnancy complications, prematurity and low birth weight. The administration of these regimens is not recommended during gestation. Whenever applied, close monitoring of the mother and the fetus is required.

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Section: Resultsmentioning

confidence: 99%

Immune checkpoint inhibitor administration during pregnancy: a case series

et al. 2021

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“…Clinically significant levels of tamoxifen and its metabolites were found to accumulate in human milk over time; therefore, exposure to tamoxifen should be avoided during breastfeeding. 70 Enrollment is now complete to POSITIVE, a prospective cohort study in women with hormone receptor-positive, early-stage breast cancer desiring pregnancy after an initial 18 to 30 months of adjuvant endocrine therapy, for whom a break in therapy for up to 2 years to attempt pregnancy/delivery/lactation is allowed, with a plan for subsequent resumption of adjuvant endocrine therapy. Although not randomly assigned, outcomes in women in POSITIVE will be assessed, and there are outcomes for women with comparable age/ tumors/treatments in SOFT/TEXT who did not interrupt therapy for pregnancy attempt.…”

Section: Duration and Interruption And Type Of Adjuvant Ovarian Function Suppression In Premenopausal Patientsmentioning

confidence: 99%

Challenges in Adjuvant Therapy for Premenopausal Women Diagnosed With Luminal Breast Cancers

Vaz-Luís

Francis

Meglio

et al. 2021

American Society of Clinical Oncology Educational Book

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More than 90% of women with newly diagnosed breast cancer present with stage I to III disease and, with optimal multidisciplinary therapy, are likely to survive their disease. Of these patients, 70% are hormone receptor–positive and candidates for adjuvant endocrine therapy. The adoption of cumulatively better adjuvant treatments contributed to improved outcomes in patients with hormone receptor–positive, early-stage breast cancer. Premenopausal women with hormone receptor–positive breast cancer often present with complex disease and have inferior survival outcomes compared with their postmenopausal counterparts. Risk stratification strategies, including classic clinicopathologic features and newer gene expression assays, can assist in treatment decisions, including adjuvant chemotherapy use and type or duration of endocrine therapy. Gene expression assays may help identify patients who can safely forgo chemotherapy, although to a lesser extent among premenopausal patients, in whom they may play a role only in node-negative disease. Patients at lower risk of recurrence can be adequately treated with tamoxifen alone, whereas higher-risk patients benefit from ovarian function suppression with tamoxifen or an aromatase inhibitor. The role of adding newer therapies such as CDK4/6 inhibitors to adjuvant endocrine therapy is not yet clear. Breast cancer treatments are associated with several side effects, with major impact on patients’ quality of life and treatment adherence, particularly in premenopausal women for whom these side effects may be more prominent as the result of the abrupt decrease in estrogen concentrations. Personalized management of treatment side effects, addressing patients' concerns, and health promotion should be an integral part of the care of premenopausal women diagnosed with luminal breast cancers.

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“…Delayed diagnosis is responsible for the worse outcome of PrBC compared to pregnancy-unrelated breast cancer, but stage-normalized survival is not different from that of age-matched non-pregnant controls (7)(8)(9)(10)(11)(12). According to most guidelines, PrBC should be managed with the same protocols as breast cancer occurring in young non-pregnant women (1,2,(13)(14)(15)(16)(17)(18). However, the condition of pregnancy adds a layer of complexity to the treatment of PrBC because the benefit for the mother must not harm the fetus (2,13,(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

“…According to most guidelines, PrBC should be managed with the same protocols as breast cancer occurring in young non-pregnant women (1,2,(13)(14)(15)(16)(17)(18). However, the condition of pregnancy adds a layer of complexity to the treatment of PrBC because the benefit for the mother must not harm the fetus (2,13,(19)(20)(21)(22). For example, chemotherapy (CT) is contraindicated during the first trimester of gestation, while it can be safely administered in the second and third trimesters (23).…”

Section: Introductionmentioning

confidence: 99%

Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study

et al. 2021

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Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.

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Update on the Management of Breast Cancer during Pregnancy

Cited by 46 publications

References 86 publications

Immune checkpoint inhibitor administration during pregnancy: a case series

Immune checkpoint inhibitor administration during pregnancy: a case series

Challenges in Adjuvant Therapy for Premenopausal Women Diagnosed With Luminal Breast Cancers

Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study

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