Contemporary multidisciplinary treatment of pregnancy-associated breast cancer

Jane L Meisel,Erica L Mayer,Shari Gelber,Lydia Schapira,Nadine M Tung,Sandra Kereakoglow,Katherina Zabicki Calvillo,Ann H Partridge,Katherine E Economy

doi:10.1186/2193-1801-2-297

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.

Highlights

It is estimated that cancer complicates as many as 1 in 1000 pregnancies, with breast cancer as the most common associated malignancy (Smith et al 2001)
Much pregnancy-associated breast cancer (PABC) research has considered this group as a whole, it is worth considering two distinct subsets – those diagnosed during pregnancy, and those diagnosed in the postpartum period (Borges & Schedin 2011)
This study examined the distribution of tumor subtypes, treatment decisions, and maternal and fetal outcomes within the cohort, and evaluated the contemporary management of PABC supported by a multidisciplinary team

Summary

Introduction

It is estimated that cancer complicates as many as 1 in 1000 pregnancies, with breast cancer as the most common associated malignancy (Smith et al 2001). Contemporary management of pregnancy-associated breast cancer (PABC) encourages continuation of pregnancy during treatment. Limitations in published data describing the safety of cancer therapy in pregnancy create challenges and dilemmas in clinical decision-making for providers caring for these patients. Prospective evaluation of the safety of antineoplastic therapy during pregnancy is methodologically difficult; most published data consist of case and cohort series (Mir et al 2008; Cardonick et al 2012a; Loibl et al 2012). Given the apparent rising incidence of PABC, PABC has been defined as breast cancer diagnosed during pregnancy and up to one year postpartum. Given the advances in contemporary management of breast cancer, including use of taxanes, “dose dense” schedules, and sentinel lymph node biopsy, it is imperative to understand whether or not these new treatments can be safely administered during pregnancy

Methods

Results

Conclusion