Contemporary multidisciplinary treatment of pregnancy-associated breast cancer

Abstract

Breast cancer diagnosed during pregnancy poses unique challenges. Application of standard treatment algorithms is limited by lack of level I evidence from randomized trials. This study describes contemporary multidisciplinary treatment of pregnancy-associated breast cancer (PABC) in an academic setting and explores early maternal and fetal outcomes. A search of the Dana-Farber/Harvard Cancer Center clinical databases was performed to identify PABC cases. Sociodemographic, disease, pregnancy, and treatment information, as well as data on short-term maternal and fetal outcomes, were collected through retrospective chart review. 74 patients were identified, the majority with early-stage breast cancer. Most (73.5%) underwent surgical resection during pregnancy, including 40% with sentinel lymph node biopsy and 32% with immediate reconstruction. A total of 36 patients received anthracycline-based chemotherapy during pregnancy; of those, almost 20% were on a dose-dense schedule and 8.3% also received paclitaxel. 68 patients delivered liveborn infants; over half were delivered preterm (< 37 weeks), most scheduled to allow further maternal cancer therapy. For the infants with available data, all had normal Apgar scores and over 90% had birth weight >10th percentile. The rate of fetal malformations (4.4%) was not different than expected population rate. Within a multidisciplinary academic setting, PABC treatment followed contemporary algorithms without apparent increase in maternal or fetal adverse outcomes. A considerable number of preterm deliveries were observed, the majority planned to facilitate cancer therapy. Continued attention to maternal and fetal outcomes after PABC is required to determine the benefit of this delivery strategy.

Exploring the safety of chemotherapy for treating breast cancer during pregnancy

“…In this small study, dose-dense chemotherapy did not seem to increase the risk of fetal or maternal complications: birthweight, gestational age at delivery, rate of growth restriction, congenital anomalies, and incidence of maternal and neonatal neutropenia were not statistically different between the two groups [70]. Another trial by Meisel et al reported maternal and fetal outcomes of 74 patients diagnosed with BCP [71]. Out of 36 patients treated with anthracycline-based therapy during pregnancy, 7 women received dose-dense AC, supported by pegfilgrastim in 4 cases and by filgrastim in 2 cases: no apparent increase in short-term adverse effects on offspring has been described [71].…”

“…Another trial by Meisel et al reported maternal and fetal outcomes of 74 patients diagnosed with BCP [71]. Out of 36 patients treated with anthracycline-based therapy during pregnancy, 7 women received dose-dense AC, supported by pegfilgrastim in 4 cases and by filgrastim in 2 cases: no apparent increase in short-term adverse effects on offspring has been described [71]. However, due to both the limited data available and the need of G-CSF support, the use of dose-dense chemotherapy in pregnant women is discouraged.…”

“…To our knowledge, only two studies evaluated the safety of dose-dense chemotherapy in pregnant patients [70,71]. Using a retrospective cohort study from a voluntary registry, Cardonick et al compared pregnancy outcomes of 10 pregnant women who received chemotherapy every 2 weeks compared with those of 99 pregnant women who received standard duration chemotherapy every 3 weeks [70].…”

Immediate microsurgical breast reconstruction in pregnant breast cancer patients

“…The authors consider reconstruction might preferably be delayed. Meisel published a cohort retrospective study of PABC and demonstrated the feasibility of optimal treatment through multidisciplinary care team management [8]. Immediate breast reconstruction was utilized in 8 of 25 patients without significant rates of adverse maternal or fetal events.…”

“…However, surgery presents potential dangers: increased blood volume, hypercoagulability, and decreased lung capacity [7]. The surgery in first trimester is often deferred, out of concern for higher risks of fetal complications [8]. The surgery might cause additional operative time, possibly exposing the fetus to the risks of a longer anesthesia, and abdominal complications.…”