Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy

Amant, Frédéric; Vandenbroucke, Tineke; Verheecke, Magali; Fumagalli, Monica; Halaška, Michael; Boere, Ingrid; Han, Sileny N.; Gzirí, Mina Mhallem; Peccatori, Fedro Alessandro; Rob, Lukáš; Lok, Christianne; Witteveen, Petronella O.; Voigt, Jens‐Uwe; Naulaers, Gunnar; Vallaeys, Lore; Heuvel, Frank Van den; Lagae, Lieven; Mertens, Luc; Claes, Laurence; Calsteren, Kristel Van

doi:10.1056/nejmoa1508913

Cited by 300 publications

(276 citation statements)

References 23 publications

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“…157,170,172,[174][175][176] However, a multicenter, prospective case-control study of children born to mothers with cancer (129 cases, 129 controls) showed no significant impact of chemotherapy treatment on cognitive, cardiac, and general development of the offspring. 177 Potential benefits and risks of chemotherapy for both the mother and fetus must be carefully evaluated before the start of treatment. Delayed treatment until after fetal maturity, with careful follow-up to rule out disease progression, is a safe option for women diagnosed with early-stage cancers.…”

Section: Management Of Cancer During Pregnancymentioning

confidence: 99%

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Coccia¹,

Pappo²,

Beaupin³

et al. 2018

J Natl Compr Canc Netw

253

194

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Section: Management Of Cancer During Pregnancymentioning

confidence: 99%

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Coccia¹,

Pappo²,

Beaupin³

et al. 2018

J Natl Compr Canc Netw

253

194

View full text Add to dashboard Cite

“…Additionally, there have been no reported adverse outcomes in paediatric development (median age 22 months), as a result of exposure to maternal cancer. 5 However, there is a lack of evidence to guide the management of metastatic breast cancer, with management being extrapolated from guidelines within the adjuvant setting. Discussions regarding termination of pregnancy have to be handled with great sensitivity, and the patient and their family have to be fully informed of all management options and potential outcomes.…”

Section: Discussionmentioning

confidence: 99%

Lesson of the month 2: Oncology, obstetrics and orthopaedics: an unusual partnership

et al. 2016

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Breast cancer diagnosed during pregnancy is a relatively uncommon event. This challenging situation presents clinicians with diffi cult decisions, often requiring a multidisciplinary approach at a time of heightened anxiety for the patient and their family. This paper describes the case of a young woman with metastatic breast cancer diagnosed in early pregnancy, and outlines how this complex clinical situation was managed. KEYWORDS : Breast cancer , chemotherapy , pregnancy , radiotherapy Case historyA 37-year-old woman, 5 months postpartum, presented to her GP in October 2014 with a right axillary mass, dyspnoea and a hoarse voice. She had no significant past medical history although while 6 months pregnant, she complained of neck pain, which she attributed to a whiplash injury. A plain cervical spine X-ray showed degenerative changes in the odontoid peg unchanged from an X-ray in 2004. A chest X-ray (CXR) showed a 5.7 cm left superior mediastinal mass, and multiple pulmonary metastases. Subsequent computerised tomography (CT) showed a left parahilar mass, multiple pulmonary metastases, enlarged right axillary nodes and para-aortic nodes. The uterus (Fig 1 ) was bulky with asymmetrical thickening of the anterior wall and an illdefined 4.4 cm soft tissue lesion seen within it. The differential diagnosis included lymphoma, metastatic breast cancer or metastases from a molar pregnancy and accordingly a betahuman chorionic gonadotropin (βhCG) was undertaken. The βhCG was markedly elevated (111,129 IU/L), consistent with a molar pregnancy, and she was referred to the Trophoblastic Tumour Centre. Of note, she recently had a negative home pregnancy test. However, trophoblastic disease was excluded, as a biopsy of the axillary mass showed an oestrogen receptor ABSTRACTLesson of the month 2: Oncology, obstetrics and orthopaedics: an unusual partnership positive, human epidermal growth factor receptor 2 positive grade III invasive ductal carcinoma. Magnetic resonance imaging (MRI) of the head (Fig 2 ) revealed a soft tissue mass at the base of the skull, involving the right occipital condyle, the lateral body of C1 and odontoid peg, with soft tissue bulging into the spinal canal. Ultrasound of the pelvis revealed a single fetus of 8 weeks of gestation with a viable heartbeat. She was referred urgently to oncology with a diagnosis of metastatic breast cancer, impending spinal cord compression and early pregnancy.When seen, her main problems were hyperemesis gravidarum and a painful neck with limited movement. There was no abnormal neurology. She was fully informed of the diagnosis and aware this was incurable. Chemotherapy with trastuzumab was recommended and it was explained that these could not safely be given during the first trimester of pregnancy. Termination was recommended, but the patient was adamant she wished to continue with the pregnancy. After full discussion of the potential risks and benefits, she received urgent palliative radiotherapy to her neck which improved her pain; however, she then complained of pa...

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“…Adriamycin and cyclophosphamide are generally well tolerated in pregnancy and suggested to be two of the chemotherapy drugs of choice for treatment of PABC in a recent expert opinion published by Lambertini, et al in which he reviews the literature to date which is admittedly limited of the safety profile of these drugs during pregnancy. The most common medical side effect of these drugs is myelosuppression in both the mother and fetus [3,5,7,9,12,13]. In one study, Rouzier demonstrated the chemosensitivity to these drugs was the same in tumors of PABC and tumors of non-pregnancy associated breast cancers [3,14].…”

Section: Discussionmentioning

confidence: 99%

“…It appears to be correlated with a higher incidence of oligohydramnios during pregnancy which can predispose to preterm labor and therefore increase fetal morbidity and mortality. Similarly, tamoxifen also increases the risk to the fetus specifically through anatomic defects including craniofacial malformations and ambiguous genitalia [9,11,12]. For these reasons, our patient was not given these classes of medications until after delivery.…”

Section: Discussionmentioning

confidence: 99%

Importance of a Multidisciplinary Approach to Breast Cancer Treatment in Pregnancy: Case Report of New Diagnosis of Pregnancy-Associated Breast Cancer

Grant¹,

DiCarlo²,

Woessner-Hoyson³

2016

J Carcinog Mutagen

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Pregnancy-Associated Breast Cancer (PABC) is a rare diagnosis and includes new diagnoses of cancer both during pregnancy as well as within the first year post-delivery. Due to its rarity, there is of yet no gold standard treatment nor is there a standardized regimen of treatment during pregnancy according to the American College of Obstetrics and Gynecology (ACOG). We report a case involving a 35-year-old gravida 2 para 1-0-0-1 who was diagnosed with clinical stage II (T2 N1) breast cancer in the early third trimester of pregnancy after physical examination revealed a palpable mass. Ultrasound-guided biopsy revealed poorly differentiated infiltrating ductal carcinoma, nuclear grade 3, with micropapillary features, estrogen receptor (ER 90%), progesterone receptor (PR 25%) positive, HER2 positive 3+ with Ki67 index 75%. After extensive counseling and discussion between Obstetrics, Maternal Fetal Medicine, Breast Surgery, Neonatal ICU, and Oncology, a decision was made to initiate neoadjuvant chemotherapy (NAC) with adriamycin and cyclophosphamide. Our patient completed 4 total NAC treatments prior to delivery followed by a regimen of weekly taxol plus herceptin and perjeta postpartum. This patient strongly desired to carry the pregnancy to term and began treatment prior to delivery, making this case unique in comparison to other publications in which treatment was delayed until after delivery, or the pregnancy was terminated prior to beginning treatment. Our case highlights the importance of a multi-disciplinary approach to counseling patients in this unique situation to allow them the autonomy to choose the treatment best for them and their baby.

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Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy

Cited by 300 publications

References 23 publications

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Lesson of the month 2: Oncology, obstetrics and orthopaedics: an unusual partnership

Importance of a Multidisciplinary Approach to Breast Cancer Treatment in Pregnancy: Case Report of New Diagnosis of Pregnancy-Associated Breast Cancer

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