Summary
Breast cancer patients who are pregnant require a treatment approach that is carefully coordinated with the entire care team, including obstetricians. While treatment of this patient population can be more complicated, the goal remains the same as those for their non-pregnant counterparts: to provide optimal patient care and achieve optimal outcomes.
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Original Article
Understanding How to Care for Breast Cancer Patients During Pregnancy
Oncology Times
By Catlin Nalley
Breast cancer patients who are pregnant require a treatment approach that is carefully coordinated with the entire care team, including obstetricians. While treatment of this patient population can be more complicated, the goal remains the same as those for their non-pregnant counterparts: to provide optimal patient care and achieve optimal outcomes.
“Patients with breast cancer diagnosed during pregnancy can be effectively treated using standard of care,” noted Jennifer K. Litton, MD, from MD Anderson Cancer Center, who recently discussed this topic during a session at the Miami Breast Cancer Conference. “Sometimes we need to modify the timing of some of the treatments, but otherwise multiple groups have shown that they do as well as non-pregnant breast cancer patients.”
Tumor biology, tumor stage, and gestational stage at diagnosis determine the appropriate approach, according to Amant et al (Lancet 2012;379(9815):570-579). “Surgery for breast cancer is possible during all trimesters of pregnancy. Radiotherapy is possible during pregnancy but, dependent on the fetal dose received, can result in poor fetal outcomes,” according to the researchers. “The decision to give radiotherapy should be made on an individual basis.
“Evidence increasingly supports administration of chemotherapy from 14 weeks of gestation onward. New breast cancer treatments might be applicable to pregnant patients, but tamoxifen and trastuzumab are contraindicated during pregnancy,” they continued. “Cancer treatment during pregnancy will decrease the need for early delivery and thus prematurity, which is a major concern in management of breast cancer in pregnancy.”
Research supports the safety and efficacy of standard treatments and, therefore, there should be minimal delays in the initiation of therapy for these patients (Oncologist 2010;15(12):1238-1247). “Prospective evaluations and long-term follow-up of children are necessary, but to date there are no significant long-term health concerns identified in children exposed to chemotherapy in utero,” according to the study authors. “In order to provide further information for this challenging clinical situation, further collaborations between registries and cancer centers is needed for long-term follow-up for both the patient and the children.”
When compared to non-pregnant patients, one study found that pregnant women with breast cancer who received chemotherapy had comparable—if not better—survival outcomes (Oncologist 2013;18(4):369-376).
Data showed that disease-free survival at 5 years was 72 percent for pregnant patients and 57 percent for the control group. Investigators reported a 5-year progression-free survival of 70 percent for pregnant patients compared to 59 percent for those who were not pregnant. Five-year overall survival was 77 percent for the pregnant cohort and 71 percent for controls, according to the study authors, who concluded that “pregnant patients with breast cancer should receive appropriate local and systemic therapy for breast cancer.”
Open lines of communication between all team members is crucial during treatment. Managing the potential challenges and side effects associated with treatment requires a multidisciplinary approach. “This takes a lot of coordination of care between the OB, medical, surgical, and radiation oncologists for optimal care,” Litton explained. “We are able to use the same anti-nausea medicine that we use for our other cancer patients and we are not seeing increased side effects from the cancer in the pregnant patients.”
The key takeaway from the session, according to Litton, is that breast cancer can be effectively treated during pregnancy. “We are seeing similar survival in pregnant and non-pregnant cancer patients,” she concluded. “[Additionally,] we are not seeing an increase in effects in the children exposed to chemotherapy in utero.”
Catlin Nalley is a contributing writer.