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Breast Cancer Research and Treatment

, Volume 115, Issue 3, pp 591–594 | Cite as

Weekly epirubicin in the treatment of gestational breast cancer (GBC)

  • Fedro A. PeccatoriEmail author
  • Hatem A. AzimJr
  • Giovanna Scarfone
  • Angiolo Gadducci
  • Cristina Bonazzi
  • Oreste Gentilini
  • Viviana Galimberti
  • Mattia Intra
  • Marzia Locatelli
  • Barbara Acaia
  • Piero Rossi
  • Saverio Cinieri
  • Liliana Calabrese
  • Aron Goldhirsch
Clinical Trial

Abstract

Background GBC is a rare disease and chemotherapy in this setting lacks a standardized approach. Patients and Methods Patients 16–30 weeks pregnant with locally advanced/metastatic disease or with high risk of recurrence after surgery were evaluated. Results Twenty patients received weekly epirubicin 35 mg/m2. Median maternal age was 37 years (23–42). Median gestational age at chemotherapy was 19 weeks. Thirteen patients were treated after surgery while 7 had locally advanced tumours of which one had liver metastases. Mean total epirubicin dose was 420 mg/m2 with a median number of 12 administrations (4–16). No grade 3–4 toxicities were observed. No foetal adverse events were observed except 1 premature delivery at 28 weeks. Births were induced by caesarean section in 12 patients at a median gestational age of 35 weeks. No malformations were reported except 1 newborn with polycystic kidney. At a median age of 2 years, neurological, cardiological and immunological development was normal in all children as reported by their parents. In 7/20 patients with evaluable disease, five had an objective response. At a median follow-up of 38 months, 17 patients are alive; 14 are disease free. Conclusions Weekly epirubicin appears safe and effective with low foetal toxicity and could be considered in GBC.

Keywords

Breast cancer Pregnancy Epirubicin Chemotherapy Safety Foetus 

References

  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRefGoogle Scholar
  2. 2.
    Berkowitz GS, Skovron ML, Lapinski RH, Berkowitz RL (1990) Delayed childbearing and the outcome of pregnancy. N Engl J Med 322:639–664Google Scholar
  3. 3.
    Haas JF (1989) Pregnancy is association with newly-diagnosed cancer: a population-based epidemiologic assessment. Int J Cancer 34:229–235. doi: 10.1002/ijc.2910340214 CrossRefGoogle Scholar
  4. 4.
    Loibl S, von Minckwitz G, Gwtn K, Ellis P, Blohmer JU, Schlegelberger B et al (2006) Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer 106:237–246. doi: 10.1002/cncr.21610 PubMedCrossRefGoogle Scholar
  5. 5.
    Boldrini R, Di Cesare M, Tamburini C (eds) (2007) Rapporto CeDAP, 2004. Italian Ministry of Health website (www.ministerosalute.it)
  6. 6.
    Ring AE, Smith IE, Jones A, Shannon C, Galani E, Ellis PA (2005) Chemotherapy for breast cancer during pregnancy: an 18-year experience from five London teaching hospitals. J Clin Oncol 23:4192–4197. doi: 10.1200/JCO.2005.03.038 PubMedCrossRefGoogle Scholar
  7. 7.
    Cardonick E, Iacobucci A (2004) Use of chemotherapy during human pregnancy. Lancet Oncol 5:283–291. doi: 10.1016/S1470-2045(04)01466-4 PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G (2005) Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 190:467–473. doi: 10.1016/j.amjsurg.2005.03.033 PubMedCrossRefGoogle Scholar
  9. 9.
    Orecchia R, Lucignani G, Tosi G (2008) Prenatal irradiation and pregnancy: the effects of diagnostic imaging and radiation therapy. Recent Results Cancer Res 178:3–20. doi: 10.1007/978-3-540-71274-9_2 PubMedCrossRefGoogle Scholar
  10. 10.
    Doll DC, Ringenberg QS, Yarbo JW (1989) Antineoplastic agents and pregnancy. Semin Oncol 16:337–346PubMedGoogle Scholar
  11. 11.
    Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G (1992) Fetal outcome after in utero exposure to cancer chemotherapy. Arch Intern Med 152:573–576. doi: 10.1001/archinte.152.3.573 PubMedCrossRefGoogle Scholar
  12. 12.
    Barthelmes L, Davidson LA, Gaffney C, Gateley CA (2005) Pregnancy and breast cancer. BMJ 330:1375–1378. doi: 10.1136/bmj.330.7504.1375 PubMedCrossRefGoogle Scholar
  13. 13.
    Bonadonna G, Gianni L, Santoro A, Bonfante V, Bidoli P, Casali P et al (1993) Drugs ten years later: epirubicin. Ann Oncol 4:359–369PubMedGoogle Scholar
  14. 14.
    Twelves CJ, O’Reilly SM, Coleman RE, Richards MA, Rubens RD (1989) Weekly epirubicin for breast cancer liver metastasis and abnormal liver biochemistry. Br J Cancer 60:938–941PubMedGoogle Scholar
  15. 15.
    Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ (2007) Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 18:1133–1144. doi: 10.1093/annonc/mdm271 PubMedCrossRefGoogle Scholar
  16. 16.
    Myers C (1988) Role of iron in anthracycline action. In: Hacker M, Lazo J, Tritton T (eds) Organ directed toxicities of anticancer drugs. Martinus Nijhoff, Boston, Mass, pp 17–30Google Scholar
  17. 17.
    Clapp C, Thebault S, Martinez de la Escalera G (2007) Hormones and pospartum cardiomyopathy. Trends Endocrinol Metab 18:329–330. doi: 10.1016/j.tem.2007.08.004 PubMedCrossRefGoogle Scholar
  18. 18.
    Yeh ET, Tong AT, Lenihan DJ, Yusuf SW, Swafford J, Champion C et al (2004) Cardiovascular complications of cancer therapy: diagnosis, pathogenesis, and management. Circulation 109:3122–3131. doi: 10.1161/01.CIR.0000133187.74800.B9 PubMedCrossRefGoogle Scholar
  19. 19.
    Hahn KM, Johnson PH, Gordon N, Kuerer H, Middleton L, Ramirez M et al (2006) Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer 107:1219–1226. doi: 10.1002/cncr.22081 PubMedCrossRefGoogle Scholar
  20. 20.
    Camaggi CM, Strocchi E, Comparsi R, Testoni F, Angelelli B, Pannuti F (1986) Biliary excretion and pharmacokinetics of 4′epidoxorubicin (epirubicin) in advanced cancer patients. Cancer Chemother Pharmacol 18:47–50. doi: 10.1007/BF00253063 PubMedCrossRefGoogle Scholar
  21. 21.
    Kushari J, Mukherjea M (1980) Studies on beta-glucuronidase of the developing human placenta. Gynecol Obstet Invest 11:119–127PubMedCrossRefGoogle Scholar
  22. 22.
    Peccatori F, Martinelli G, Gentilini O, Goldhirsch A (2004) Chemotherapy during pregnancy: what is really safe? Lancet Oncol 5:398. doi: 10.1016/S1470-2045(04)01506-2 PubMedCrossRefGoogle Scholar
  23. 23.
    Partridge AH, Garber JE (2000) Long-term outcomes of children exposed to antineoplastic agents in utero. Semin Oncol 27:712–726PubMedGoogle Scholar
  24. 24.
    Gwyn K (2005) Children exposed to chemotherapy in utero. J Natl Cancer Inst Monogr 34:69–71. doi: 10.1093/jncimonographs/lgi009 PubMedCrossRefGoogle Scholar
  25. 25.
    Aviles A, Neri N, Nambo MJ (2006) Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy. Ann Oncol 17:286–288. doi: 10.1093/annonc/mdj053 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Fedro A. Peccatori
    • 1
    Email author
  • Hatem A. AzimJr
    • 1
  • Giovanna Scarfone
    • 2
  • Angiolo Gadducci
    • 3
  • Cristina Bonazzi
    • 4
  • Oreste Gentilini
    • 5
  • Viviana Galimberti
    • 5
  • Mattia Intra
    • 5
  • Marzia Locatelli
    • 1
  • Barbara Acaia
    • 2
  • Piero Rossi
    • 2
  • Saverio Cinieri
    • 1
    • 6
  • Liliana Calabrese
    • 1
  • Aron Goldhirsch
    • 1
  1. 1.Department of MedicineEuropean Institute of OncologyMilanItaly
  2. 2.Division of Obstetrics and Gynaecology, IRCCS Policlinico, Mangiagalli and Regina ElenaUniversity of MilanMilanItaly
  3. 3.Division of Obstetrics and GynaecologyPisa UniversityPisaItaly
  4. 4.Division of Obstetrics and GynaecologyBicocca UniversityMonzaItaly
  5. 5.Division of SenologyEuropean Institute of OncologyMilanItaly
  6. 6.Division of Medical OncologyPerrino HospitalBrindisiItaly

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