Second Trimester Chemo Did Not Harm Fetus

Major Finding: Median overall birth weight was 2,760 g for 121 newborns exposed in the second trimester to chemotherapy and 2,785 g for the 36 newborns not exposed. Median postpartum hemoglobin levels were 16.1 g/dL and 17.2 g/dL, respectively.

Data Source: A German Breast Cancer Group registry of 235 women who were diagnosed while pregnant.

Disclosures: No disclosures were given.

BARCELONA — Women who are diagnosed with breast cancer while pregnant can be treated with standard chemotherapy regimens after the 12th gestational week without endangering the health of the fetus, according to data from a registry established by the German Breast Group.

Fetal outcomes were not significantly different when 121 newborns of women who were treated with chemotherapy were compared with 36 newborns of women who did not receive chemotherapy in pregnancy, according to a poster.

“Breast cancer is among the most common cancers diagnosed during pregnancy,” said lead author Dr. Sibylle Loibl of Johann Wolfgang Goethe University in Frankfurt-am-Main, Germany. Approximately 3% of all breast cancer cases are diagnosed during pregnancy.

In all, 235 women with gestational breast cancer were registered in the German database between April 2003 and October 2008. The investigators' primary aim was to evaluate fetal outcomes 4 weeks after delivery; they also plan to evaluate outcomes in the children and their mothers at 5 years after therapy.

The median age of the women was 33 years (range, 24-46 years). The diagnosis of breast cancer was made during the first trimester in 23.8% of women. Corresponding figures for the second and third trimesters were 39.5% and 36.8%, respectively.

All told, 121 women received cytotoxic chemotherapy during pregnancy. This mostly consisted of anthracyclines in 58.6%, FEC (5-fluorouracil, epirubicin, and cyclophosphamide) in 16.5%, or CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) in 14%. A median of four cycles of chemotherapy was received during pregnancy.

The majority (57.1%) of women had T2 tumors, with T3 tumors found in 25.8%, T1 in 11.5% of cases, and T4 in 4.4%. About half had node-positive disease, and 7.9% had metastatic (M1) disease. Most tumors (93.4%) were described as ductal invasive/other.

Median overall birth weight was unaffected by chemotherapy during pregnancy, at 2,760 g for 121 newborns who were exposed and 2,785 g for the 36 newborns who were not. No significant differences in postpartum hemoglobin levels were found, with median hemoglobin levels of 16.1 g/dL and 17.2 g/dL, respectively.

“I think pregnant women should and can be treated with standard treatments as recommended by the international guidelines,” Dr. Loibl said. Events that occurred in fetal outcome “were similar in both groups, but we need more information on cytotoxic agents that are more commonly used, such as the taxanes.”

These findings suggest that “there is no harm done to the child when women who are pregnant take chemotherapy,” said Ellen Verschuur-van der Voort, vice president of the Dutch Breast Cancer Association and president of the Europa Donna Forum, the Netherlands.

The research gave “a very good and positive conclusion,” offering reassurance to women who are diagnosed with breast cancer while pregnant, she added.

'Pregnant women should and can be treated with standard treatments' for breast cancer.

Source DR. LOIBL