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

Abstract

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.

Contemporary multidisciplinary treatment of pregnancy-associated breast cancer

“…Case reports have described multiple fetal complications after prenatal exposures to these agents (Gottschalk et al 2011; Braems et al 2011; Witzel et al 2008). Trastuzumab has been associated with oligohydramnios, and a boxed warning for teratogenicity has been issued, contraindicating the use of trastuzumab in pregnancy.…”

Exploring the safety of chemotherapy for treating breast cancer during pregnancy

“…Only one major malformation (i.e., pyloric stenosis) was described with the use of docetaxel administered in the second and third trimester [57]. A total of four pregnancies in patients exposed to docetaxel experienced reduction in amniotic fluid: however, trastuzumab was co-administered in two of them [58,59] and the third pregnancy was complicated by placental insufficiency [60]. A high rate of small for gestational age birth weights has been observed in children exposed to docetaxel [28].…”

Children Exposed to Treatments in Utero in Pregnant Patients with Breast Cancer: Experience from Two Large Egyptian Hospitals

“…Fortunately, adjuvant regimens containing trastuzumab for the treatment of her2 positive disease start with anthracyclines based chemotherapy, so give the time for a pregnant patient to give birth before starting trastuzumab. The start of treatment can be delayed until completion of pregnancy without adversely affecting the survival outcomes 36 . In our series, one child was exposed during 1 st trimester to 4 cycles of trastuzumab without neonatal or postnatal adverse effects.…”