Treating Advanced Breast Cancer in a Pregnant Woman?
Treating Advanced Breast Cancer in a Pregnant Woman?
A 38-year-old woman who is in her 20th week of pregnancy has stage IIIb breast cancer (T4bN2M0). She received 2 courses of doxorubicin and cyclophosphamide, but has local progressive disease, and is not considered a candidate for surgery. What would you recommend at this point?
Breast cancer complicating pregnancy is always difficult to manage; presence of locally advanced and unresponsive breast cancer is even more so. There is no standard approach, but given the relative safety of doxorubicin during pregnancy, it has been the main treatment option for most clinicians.
Following progression of disease, however, the choice of therapeutics with any track record for safety in pregnancy is markedly limited. All subsequently used agents will have some potential for harm to the developing fetus and there are no guidelines for further therapy. Based on activity in anthracycline-resistant tumors, single-agent taxane therapy would probably be appropriate, but the patient would have to be counseled regarding the lack of safety data in pregnancy. Delivery of the child at the earliest safe moment would facilitate further treatment.
A 38-year-old woman who is in her 20th week of pregnancy has stage IIIb breast cancer (T4bN2M0). She received 2 courses of doxorubicin and cyclophosphamide, but has local progressive disease, and is not considered a candidate for surgery. What would you recommend at this point?
Breast cancer complicating pregnancy is always difficult to manage; presence of locally advanced and unresponsive breast cancer is even more so. There is no standard approach, but given the relative safety of doxorubicin during pregnancy, it has been the main treatment option for most clinicians.
Following progression of disease, however, the choice of therapeutics with any track record for safety in pregnancy is markedly limited. All subsequently used agents will have some potential for harm to the developing fetus and there are no guidelines for further therapy. Based on activity in anthracycline-resistant tumors, single-agent taxane therapy would probably be appropriate, but the patient would have to be counseled regarding the lack of safety data in pregnancy. Delivery of the child at the earliest safe moment would facilitate further treatment.
