SAN ANTONIO – Early maternal and infant outcomes in a large German registry of women diagnosed with breast cancer during pregnancy argue in favor of treating breast cancer while continuing the pregnancy rather than resorting to early delivery by cesarean section in order to begin chemotherapy after the baby is born, according to Dr. Sibylle Loibl.
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Dr. Sibylle Loibl
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"Patients should be treated as closely as possible to standard recommendations for nonpregnant women," declared Dr. Loibl of University Women’s Hospital, Frankfurt.
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In this regard, the experience gleaned from the combined prospective and retrospective registry, which is supported by the Breast International Group and German Breast Group, supports newly published recommendations (Eur. J. Cancer 2010;46:3,158-68) issued by an international expert consensus panel of which Dr. Loibl was a member.
About 2% of all breast cancers are diagnosed during pregnancy. These are difficult cases that generate anxiety because of the need to weigh treatment of the mother and the interests of her developing child. With many women delaying childbirth until later in life, breast cancers in pregnancy may be increasing, according to Dr. Loibl.
The Breast Cancer During Pregnancy (BCP) registry to date includes 313 women with breast cancer of various stages and subtypes diagnosed during pregnancy. Forty-two percent of women were in their second trimester at the time of diagnosis, 23% were in the first trimester, and the rest were in the third.
Twenty-nine women miscarried or elected to have an abortion. Of the remainder, 49% were delivered by cesarean section. Half of women underwent mastectomy, and half had breast-conserving surgery, Dr. Loibl reported at the San Antonio Breast Cancer Symposium.
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A total of 142 women in the BCP registry underwent chemotherapy during pregnancy, and 118 others had chemotherapy after delivery. Patients who underwent chemotherapy during pregnancy were diagnosed with breast cancer at a median gestational age of 20 weeks, compared with 28 weeks for those who had chemotherapy after delivery.
Of note, 17% of women who underwent chemotherapy during pregnancy delivered before gestational week 35, compared with fully 33% of those who didn’t start chemotherapy until after delivery. The high rate of early delivery in the latter group was largely the consequence of a management strategy seeking to start chemotherapy as soon as possible without a fetus on board. But it’s well-established that preterm delivery carries a price in terms of infant morbidity – and the BCG registry data indicate there is no reason to go that route, according to Dr. Loibl.
Patients who underwent chemotherapy during pregnancy received a median of four cycles. Seventy-seven percent received an anthracycline-based regimen. Only six women received a taxane during pregnancy.
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