Management of HER2-positive breast cancer during pregnancy: a case report

Abstract

Introduction: Breast cancer is one of the most common malignancies diagnosed during pregnancy, with an incidence of 1:3000 pregnancies. Its rising incidence is related to the trend to postpone childbearing during the last 30 years. Breast cancer during pregnancy should not be managed differently from the nonpregnant setting. Chemotherapy is reported to be safe after the first trimester, whereas trastuzumab and tamoxifen are contraindicated regardless of the trimester. Case description: A patient diagnosed with breast cancer recurrence during pregnancy was exposed to both tamoxifen and trastuzumab during the first two trimesters of pregnancy. In addition, docetaxel was administered during the second and third trimesters, without subsequent fetal malformations or obstetric complications. Conclusions: When conception occurs inadvertently during assumption of tamoxifen or anti-HER2 agents, their effects on the fetus and on the course of pregnancy are not completely understood. Further studies are needed in this setting, highlighting the importance to share clinical experiences.

Trastuzumab administration during pregnancy: an update

“…Trastuzumab was administered during pregnancy as a monotherapy regimen in most cases [22,25,27,28,31,32,34,36,39,43,[45][46][47][48] or in combination with pertuzumab [24], vinorelbine [26,35], paclitaxel [21,49], docetaxel [33,41], docetaxel and carboplatin [44], tamoxifen [29,30,37], tamoxifen and lapatinib [42], docetaxel and cyclophosphamide [40], doxorubicin and cyclophosphamide and paclitaxel [38] and also concurrently with brain RT in one case [42]. The mean age of patients at pregnancy was 31.1 years (SD: 3.96; median: 31.5; range [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] [21, 22, 24-37, 39, 41, 43, 44, 46-49], while the mean age at breast cancer diagnosis was 29.9 years (SD: 4.21; median: 30.0; range: 22-38)…”

Trastuzumab Administration During Pregnancy: Un Update

“…Trastuzumab was administered during pregnancy as a monotherapy regimen in most cases [22, 25, 45-48, 27, 28, 31, 32, 34, 36, 42, 43] or in combination with pertuzumab [24], vinorelbine [26,35], paclitaxel [21,49], docetaxel [33,39], docetaxel and carboplatin [44], tamoxifen [29,30,37], tamoxifen and lapatinib [40], docetaxel and cyclophosphamide [38], doxorubicin and cyclophosphamide and paclitaxel [41] and also concurrently with brain RT in one case [40] Evaluating available histologies, invasive ductal carcinoma (IDC) was diagnosed in all known cases [21, 22, 33-37, 39, 41-44, 24, 46, 48, 25-27, 29-32], while in one case invasive lobular carcinoma (ILC) co-existed [32]. The tumor was estrogen receptor (ER) -positive in 23 % of the cases [25,29,30,32,37,44]and progesterone receptor (PR) -positive in 20,8% of the cases [22,25,37,44,49]. Breast cancer was human epidermal growth factor receptor 2 (HER2)positive in all included cases [21, 22, 32-41, 24, 42-49, 25-31].…”

“…In thirteen cases (43.3 %), a completely healthy neonate (thirteen out of 32 neonates) was born [21,25,41,45,46,26,31,[33][34][35][36][37]39]. In the remaining cases, neonates presented with: renal agenesis/hypoplasia (2 cases) [24,47], mild transient tachypnoea (three cases) [27,28,48], respiratory distress syndrome (six cases) [22,38,42,43,45,49], respiratory failure (two cases) [29,32], renal failure (three cases) [29,47,49], transient respiratory failure and elevated creatinine (one case) [29], severe pulmonary hypoplasia (one case) [30], capillary leak syndrome and necrotizing enterocolitis (one case) [32], pulmonary hypertension and persistence of arterial canal (one case) [42], prematurity-related disorders (two cases) [44,47], conductive hearing loss and mild hypertonia/hyperre exia (one case) [45], bacterial sepsis (one case) [49] and cardiorespiratory arrest (one case) [22].…”

“…Trastuzumab was administered during pregnancy as a monotherapy regimen in most cases [22, 25, 45-48, 27, 28, 31, 32, 34, 36, 42, 43] or in combination with pertuzumab [24], vinorelbine [26,35], paclitaxel [21,49], docetaxel [33,39], docetaxel and carboplatin [44], tamoxifen [29,30,37], tamoxifen and lapatinib [40], docetaxel and cyclophosphamide [38], doxorubicin and cyclophosphamide and paclitaxel [41] and also concurrently with brain RT in one case [40]. The mean age of patients at pregnancy was 31.1 years (SD: 3.96; median: 31.5; range [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] [21, 22, 32-37, 39, 42-44, 24, 46-49, 25-31], while the mean age at breast cancer diagnosis was 29.9 years (SD: 4.21; median: 30.0; range: [22][23][24][25][26][27][28][29][30][31][32][33][34]<...>…”

“…Evaluating available histologies, invasive ductal carcinoma (IDC) was diagnosed in all known cases [21, 22, 33-37, 39, 41-44, 24, 46, 48, 25-27, 29-32], while in one case invasive lobular carcinoma (ILC) co-existed [32]. The tumor was estrogen receptor (ER) -positive in 23 % of the cases [25,29,30,32,37,44]and progesterone receptor (PR) -positive in 20,8% of the cases [22,25,37,44,49]. Breast cancer was human epidermal growth factor receptor 2 (HER2)positive in all included cases [21, 22, 32-41, 24, 42-49, 25-31].…”