After Chemotherapy Treatment for Maternal Cancer During Pregnancy, Is Breastfeeding Possible?

We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.

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“…Breastfeeding is allowed if there is no ongoing chemotherapy or targeted therapy, if the time since last administration is at least 3 weeks [76].…”

Section: Obstetrical Carementioning

confidence: 99%

Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting

et al. 2019

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“…Chemotherapy. Patients who receive chemotherapy during pregnancy demonstrate markedly reduced lactational ability, particularly when they receive therapy earlier during pregnancy and/or when they complete more cycles 30 (Level 3). Chemotherapy is contraindicated during the first trimester and generally is paused 3 to 4 weeks preceding delivery 24 (Level 4).…”

Section: (Level 4)mentioning

confidence: 99%

ABM Clinical Protocol #34: Breast Cancer and Breastfeeding

Johnson

Mitchell

2020

Breastfeeding Medicine

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A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. Background B reast cancer is the most common malignancy in women worldwide, with 1 in 20 women developing the disease during her lifetime. 1 It represents the leading cause of cancer deaths and disability-adjusted life-years among women. 1 In addition, breast cancer imparts significant morbidity to women and children through its impacts on breastfeeding. Breast cancer treatments may affect breastfeeding in multiple ways. Breastfeeding women diagnosed with breast cancer may require medications or therapies that decrease milk production or are contraindicated during lactation. Women treated for breast cancer before or during pregnancy may have reduced lactational capacity due to surgical removal of breast tissue and/or irreversible effects of prior therapies. Given these unique challenges and the multitude of health risks associated with not breastfeeding, 2 women with a new or remote breast cancer diagnosis require unique support of lactation. The aim of this protocol is to guide clinicians in the delivery of optimal care of breastfeeding women as it relates to breast cancer, from screening to diagnosis, treatment, and survivorship. Throughout this protocol, the quality of evidence, based on the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence 3 (Levels 1-5), is noted in parentheses. Recommendations Screening breastfeeding women for breast cancer Breastfeeding management in women with a history of breast cancer As breast cancer treatments may reduce lactational capacity, women with a history of breast cancer who would like

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“…One study compared women who underwent chemotherapy during pregnancy with non-exposed women. That study found a significant difference in patient perception of reduced milk supply and a greater need to supplement the diets of their infants [21].…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy and anti-HER2 therapy in metastatic breast cancer in pregnancy followed by surgical treatment

Berwart

Peccatori

2019

ecancer

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Between 5% and 10% of women have distant metastases when they receive a breast cancer (BC) diagnosis. Metastatic BC is associated with poor prognosis but advances in systemic treatments have improved survival rates in recent decades. Debates about local primary tumour management in metastatic stages continue, but multiple studies have shown that primary tumour surgery can be beneficial. BC is one of the most commonly diagnosed neoplasias during pregnancy. Treatment of pregnant BC patients should follow the standard treatment of young, non-pregnant patients as closely as possible. We present the case of a young, pregnant patient with metastatic BC with a complete clinical response to chemotherapy followed by surgical treatment.

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After Chemotherapy Treatment for Maternal Cancer During Pregnancy, Is Breastfeeding Possible?

Abstract: Women who undergo chemotherapy during a pregnancy are more likely to report breastfeeding difficulties.

Cited by 25 publications

References 33 publications

Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting

Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting

ABM Clinical Protocol #34: Breast Cancer and Breastfeeding

Chemotherapy and anti-HER2 therapy in metastatic breast cancer in pregnancy followed by surgical treatment

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