Chemotherapy for Breast Cancer During Pregnancy

  • Breast cancers during pregnancy:
    • Are often locally advanced due to delays in diagnosis, and many of these young patients will require chemotherapy
  • Systemic treatment of breast cancer during pregnancy:
    • Involves special consideration of both the mother and the baby
  • Data from a single-institution prospective study:
    • Reported on 40 pregnant women initially and updated their series years later to include 57 women:
      • Treated with FAC chemotherapy (5-FU, doxorubicin, and cyclophosphamide):
        • During the second and third trimesters
    • Investigators concluded:
      • This regimen to be safe as fetal malformations occurred only 1.3% of the time:
        • Which was similar to the rate of malformations seen in fetuses not exposed to chemotherapy
  • Methotrexate is contraindicated in all trimesters:
    • As its method of action is as an antimetabolite and anti-folate agent
  • Although limited data exist on taxane-based therapies:
    • The NCCN recommends that if needed:
      • It should be given with weekly dosing
  • Anti-HER2 therapy with either trastuzumab or pertuzamab:
    • Is contraindicated during pregnancy:
      • With case reports associating oligohydramnios or anhydramnios with therapy
  • First-trimester chemotherapy:
    • Is contraindicated based on:
      • An increased risk of:
        • Fetal malformation
        • Stillbirth
        • Miscarriage
  • Second- and third-trimester chemotherapy:
    • Appears to be safe:
      • But may be associated with:
        • Intrauterine growth retardation
        • Prematurity
        • Low birth weight
  • Chemotherapy:
    • Should not be given after 35 weeks’ gestation or within 3 weeks of planned delivery:
      • The median gestational age is 38 weeks with more than 50% of babies born by vaginal delivery
  • Breastfeeding while on chemotherapy:
    • Is contraindicated due to excretion of drugs into breast milk

REFERENCES

  1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines for Oncology: Breast Cancer. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp Published January 2016. Accessed January 29, 2017.
  2. Amant F, Deckers S, Van Calsteren K, et al. Breast cancer in pregnancy: Recommendations of an international consensus meeting. Eur J Cancer. 2010;46:3158-3168.
  3. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. A Reference Guide to Fetal and Maternal Risk. 6th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006.
  4. Gwyn K, Theriault R. Breast cancer during pregnancy. Oncology (Williston Park). 2001; 15(1):39-46.
  5. Hahn KM, Johnson PH, Gordon N, et al. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer. 2006:107(6):1219-1226.

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