Abstract
Background
Guidelines support comparable treatment for women diagnosed with breast cancer during pregnancy (PrBC) and nonpregnant women with limited case-specific modifications to ensure maternal–fetal safety. Experience during pregnancy with modern agents, such as taxanes or granulocyte colony-stimulating factors (GCSF), is limited.
Patients and methods
We retrospectively identified a multi-institutional cohort of PrBC between 1996 and 2020. Propensity score analyses with multiple imputation for missing variables were applied to determine the associations between chemotherapy exposures during pregnancy, with or without taxanes or GCSF, and a compound maternal–fetal outcome including spontaneous preterm birth, preterm premature rupture of membranes, chorioamnionitis, small for gestational age newborns, congenital malformation, or 5-min Apgar score < 7.
Results
Among 139 PrBC pregnancies, 82 (59.0%) were exposed to chemotherapy, including 26 (31.7%) to taxane and 18 (22.0%) to GCSF. Chemotherapy use, in general, and inclusion of taxane and/or GCSF, specifically, increased over time. Pregnancies resulting in live singleton births (n = 123) and exposed to chemotherapy were as likely to reach term as those that were not (59.5% vs. 63.6%, respectively, punadjusted = 0.85). Among women treated with chemotherapy, propensity score-matched odds ratios (OR) for the composite maternal–fetal outcome were not significantly increased with taxane (OR 1.24, 95% CI 0.27–5.72) or GCSF (OR 2.11, 95% confidence interval (CI) 0.48–9.22) with similar effects in multiple imputation and sensitivity models.
Conclusion
The judicious increased use of taxane chemotherapy and/or growth factor support during pregnancy was not associated with unfavorable short-term maternal–fetal outcomes. While these findings are reassuring, case numbers remain limited and continued surveillance of these patients and progeny is warranted.
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Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
Tal Sella is supported by the Goldfarb Advanced Fellowship in Breast Oncology at Dana-Farber Cancer Institute and is also supported by The American Physicians Fellowship for Medicine in Israel and the Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.
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Conceptualization was performed by TS, PE, ELM, and AHP; methodology, formal analysis, and investigation were performed by TS, PE, SR, TSF, NT, and ELM; writing—original draft preparation was carried out by TS and PE; writing—review and editing was performed by all authors; and resources and supervision were performed by ELM.
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Heather A. Parsons has received funding to the institution from Puma. Nancy U. Lin has received grant/contract funding to the institution from Genentech, Merck, Pfizer, Seattle Genetics, Zion Pharmaceuticals, Olema Pharmaceuticals, and AstraZeneca; consulting fees/honorarium for consulting/ad board participation from Puma, Seattle Genetics, AstraZeneca, Daiichi-Sankyo, Denali Therapeutics, Olema Pharma, Prelude Therapeutics, Aleta BioPharma, Voyager Therapeutics, Affinia Therapeutics, and Pfizer; royalties from UpToDate; and stock and other ownership interests in Artera Inc. Nadine M. Tung has received research funding from AstraZeneca. Erica L. Mayer has received consulting/advising fees from Novartis, Lilly, Gilead, and AstraZeneca. All remaining authors declared that they have no conflict of interest.
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Presented as a poster at the 2018 San Antonio Breast Cancer Symposium; December 4–8, 2018; San Antonio, Texas.
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Sella, T., Exman, P., Ren, S. et al. Outcomes after treatment of breast cancer during pregnancy including taxanes and/or granulocyte colony-stimulating factor use: findings from a multi-institutional retrospective analysis. Breast Cancer Res Treat 194, 597–606 (2022). https://doi.org/10.1007/s10549-022-06621-4
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DOI: https://doi.org/10.1007/s10549-022-06621-4