Adjuvant Therapy in Patients with Breast Cancer During Pregnancy

  • Sibylle LoiblEmail author
Part of the Cancer Treatment and Research book series (CTAR, volume 151)


Breast cancer is one of the most commonly diagnosed cancers during pregnancy accounting for 1/3,000 pregnancies. It is believed that the incidence of breast cancer during pregnancy (BCP) will increase as more women delay child-bearing and because the incidence of breast cancer increases with increasing age.


Breast Cancer Sentinel Lymph Node Sentinel Lymph Node Biopsy Granulocyte Colony Stimulate Factor Invasive Lobular Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Parente JT, Amsel M, Lerner R, Chinea F. Breast cancer associated with pregnancy. Obstet Gynecol. 1988;71:861–4.PubMedGoogle Scholar
  2. 2.
    Tobon H, Horowitz LF. Breast cancer during pregnancy. Breast Dis. 1993;6:127–34.Google Scholar
  3. 3.
    King RM, Welch JS, Martin JK Jr, Coulam CB. Carcinoma of the breast associated with pregnancy. Surg Gynecol Obstet. 1985;160:228–32.PubMedGoogle Scholar
  4. 4.
    Fisher CJ, Egan MK, Smith P, Wicks K, Millis RR, Fentiman IS. Histopathology of breast cancer in relation to age. Br J Cancer. 1997;75:593–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Shousha S. Breast carcinoma presenting during or shortly after pregnancy and lactation. Arch Pathol Lab Med. 2000;124:1053–60.PubMedGoogle Scholar
  6. 6.
    Ishida T, Yokoe T, Kasmu F, et al. Clinicopathologic characteristics and prognosis of breast cancer patients associated with pregnancy and lactation: Analysis of case-control study in Japan. Jpn J Cancer Res. 1992;83:1143–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Middleton LP, Amin M, Gwyn K, Theriault R, Sahin A. Breast carcinoma in pregnant women: Assessment of clinicopathologic and immunohistochemical features. Cancer. 2003;98;1055–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Maru D, Middleton LP, Wang S, Valero V, Sahin A. HER-2/neu and p53 overexpression as biomarkers of breast carcinoma in women age 30 years and younger. Cancer. 2005;103:900–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Elledge RM, Ciocca DR, Langone G, McGuire WL. Estrogen receptor, progesterone receptor, and HER-2/neu protein in breast cancers from pregnant patients. Cancer. 1993;71:2499–506.PubMedCrossRefGoogle Scholar
  10. 10.
    Lebeau A, Deimling D, Kaltz C, Sendelhofert A, Iff A, Luthardt B, et al. Her-2/neu analysis in archival tissue samples of human breast cancer: Comparison of immunohistochemistry and fluorescence in situ hybridization. J Clin Oncol. 2001;19: 354–63.PubMedGoogle Scholar
  11. 11.
    Berry DL, Theriault RL, Holmes FA, Parisi VM, Booser DJ, Singletary SE, Buzdar AU, Hortobagyi GN. Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol. 1999;17:855–61.PubMedGoogle Scholar
  12. 12.
    Hahn K, Johnson PE, Gordon N, Kuerer H, Middleton L, Ramirez M, Yang W, Perkins G, Hortobagyyi GN, Theriault RL. Treatment of pregnant breast cancer patients and outcomes of children exposed to vhemotherapy in utero. Cancer 2006;upub ahead of printGoogle Scholar
  13. 13.
    Kalter H, Warkany J. Congenital malformations. N Engl J Med. 1983;308:424–31,491–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Doll DC, Ringenberg QS. Yarbro JW. Antineoplastic Agents in Pregnancy. Sem Oncol. 1989;16:337–46.Google Scholar
  15. 15.
    Ebert U, Löffler H, Kirch W. Cytotoxic therapy and pregnancy. Pharmacol Ther. 1997;74:207–20.PubMedCrossRefGoogle Scholar
  16. 16.
    Woo JC, Yu T, Hurd TC. Breast Cancer in pregnancy: A literature review. Arch Surg. 2003;138:91–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Giacalone PL, Laffargue F, Benos P. Chemotherapy for breast carcinoma during pregnancy: A French national survey. Cancer. 1999;86:2266–72.PubMedCrossRefGoogle Scholar
  18. 18.
    Warkany J. Aminopterin and methotrexate: Folic acid deficiency. Teratology. 1978;17:353–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Feldkamp M, Carey JC. Clinical teratology counseling and consultation case report: Low dose methotrexate exposure in the early weeks of pregnancy. Teratology. 1993;47:533–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Maghfoor I, Doll DC. Chemotherapy in pregnancy. In: Perry MC, ed. The chemotherapy source book. 3rd ed. 537–46.Google Scholar
  21. 21.
    Glantz JC. Reproductive toxicology of alkylating agents. Obstet Gynecol Surv. 1994;49:709–15.PubMedCrossRefGoogle Scholar
  22. 22.
    Garcia V, Miguel JS, Borrasca AL. Doxorubicin in the first trimester of pregnancy. Ann Intern Med. 1981;94:547.PubMedGoogle Scholar
  23. 23.
    Germann N, Goffinet F, Goldwasser F. Anthracyclines during pregnancy: Embryo-fetal outcome in 160 patients. Ann Oncol. 2004;15:146–50.PubMedCrossRefGoogle Scholar
  24. 24.
    De Santis M, Lucchese A, De Carolis S, Ferrazani S, Caruso A. Metastatic breast cancer in pregnancy: first case of chemotherapy with docetaxel. Eur J Cancer Care. 2000;9:235–7.CrossRefGoogle Scholar
  25. 25.
    Gadducci A, Cosio S, Fanucchi A, et al. Chemotherapy with epirubicin and paclitaxel for breast cancer during pregnancy: Case report and review of the literature. Anticancer Res. 2003;23:5225–9.PubMedGoogle Scholar
  26. 26.
    Gonzalez-Angulo AM, Walters RS, Carpenter RJ, et al. Paclitaxel chemotherapy in a pregnant patient with bilateral breast cancer. Clin Breast Cancer. 2004;5:317–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Nieto Y, Santiseban M, Aramendia JM, Fernandez-Hidalgo O, Garcia-Manerom, Lopez G. Docetaxel administered during pregnancy for inflammatory breast carcinoma. Clin Breast Cancer. 2006;6:533–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Little BB. Pharmacokinetics during pregnancy: Evidence-based maternal dose formulation. Obstet Gynecol. 1999;93:658–68.CrossRefGoogle Scholar
  29. 29.
    Mucklow JC. The fate of drugs in pregnancy. Clin Obstet Gynecol. 1986;13:161–75.Google Scholar
  30. 30.
    Arceci RJ, Croop JM, Horwitz SB, Housman D. The gene encoding multidrug resistance is induced and expressed at high levels during pregnancy in the secretory epithelium of the uterus. Proc Natl Acad Sci U S A. 1988;85:4350–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Smit JW, Huisman MT, van Tellingen O, Wiltshire HR, Schinkel AH. Absence or pharmacological blocking of placental P-glycoprotein profoundly increases fetal drug exposure. J Clin Invest. 1999;104:1441–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Gedeon C, Koren G. Designing pregnancy centered medications: drugs which do not cross the human placenta. Placenta. 2006;27:861–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Evseenko DA, Paxton JW, Keelan JA. ABC drug transporter expression and functional activity in trophoblast-like cell lines and differentiating primary trophoblast. Am J Physiol Regul Intergr Comp Physiol. 2006;290:R1357–65.CrossRefGoogle Scholar
  34. 34.
    Aviles A, Neri N. Hematological Malignancies and Pregnancy: A Final Report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001;2:173–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Kremer LC, van Dalen EC, Offringa M, Ottenkamp J, Voute PA. Anthracycline-induced clinical heart failure in a cohort of 607 children: Long-term follow-up study. J Clin Oncol. 2001;19:191–6.PubMedGoogle Scholar
  36. 36.
    Kremer LC, van der Pal HJ, Offringa M, van Dalen EC, Voute PA. Frequency and risk factors of subclinical cardiotoxicity after anthracycline therapy in children: A systematic review. Ann Oncol. 2002;13:819–29.PubMedCrossRefGoogle Scholar
  37. 37.
    Kremer LC, van Dalen EC, Offringa M, Voute PA. Frequency and risk factors of anthracycline-induced clinical heart failure in children: A systematic review. Ann Oncol. 2002;13:503–12PubMedCrossRefGoogle Scholar
  38. 38.
    Meyer-Wittkopf M, Barth H, Emons G, Schmidt S. Fetal cardiac effects of doxorubicin therapy for carcinoma of the breast during pregnancy: Case report and review of the literature. Ultrasound Obstet and Gynecol. 2001;18:62–6.CrossRefGoogle Scholar
  39. 39.
    Cunha GR, Taguchi O, Namikawa R, Nishizuka Y, Robboy SJ. Teratogenic effects of clomiphene, tamoxifen, and diethylstilbestrol on the developing human female genital tract. Hum Pathol. 1987;18:1132–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Oksuzoglu B, Guler N. An infertile patient with breast cancer who delivered a healthy child under adjuvant tamoxifen therapy. Eur J Obstet Gynecol Reprod Biol. 2002;104:79.PubMedCrossRefGoogle Scholar
  41. 41.
    Isaacs RJ, Hunter W, Clark K. Tamoxifen as systemic treatment of advanced breast cancer during pregnancy-case report and literature review. Gynecologic Oncology. 2001;80:405–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Cullins SL, Pridjian G, Sutherland CM. Goldenhar's syndrome associated with tamoxifen given to the mother during gestation. JAMA. 1994;271:1905–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Tewari K, Bonebrake RG, Asrat T, Shanberg AM. Ambiguous genitalia in infant exposed to tamoxifen in utero. Lancet. 1997;350:183.PubMedCrossRefGoogle Scholar
  44. 44.
    Watson WJ. Herceptin (trastuzumab) therapy during pregnancy: Association with reversible anhydramnios. Obstet Gynecol. 2005;105:642–3.PubMedCrossRefGoogle Scholar
  45. 45.
    Fanale MA, Uyei AR, Theriault RL, Adam K, Thompson RA. Treatment of metastatic breast cancer with trastuzumab and vinorelbine during pregnancy. Clin Breast cancer. 2005;6:354–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Waterston AM, Graham J. Effect of adjuvant trastuzumab on pregnancy. J Clin Oncol. 2006;24:321–2.PubMedCrossRefGoogle Scholar
  47. 47.
    Culbert EC, Schfirin BS. Malignant hypercalcemia in pregnancy: Effect of pamidroinate on uterine contractions. Obstet Gynecol. 2006;108:789–91.PubMedCrossRefGoogle Scholar
  48. 48.
    Illidge TM, Hussey M, Godden CW. Malignant hypercalcemia in pregnancy and antenatal administration of intravenous pamidronate. Clin Oncol. 1996;8:257–8.CrossRefGoogle Scholar
  49. 49.
    Bsat FA, Hoffman DE, Seubert DE. Comparison of three outpatient regimens in the management of nausea and vomiting in pregnancy. J Perinatol. 2003;23:531–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Mahajan MK, Singh V. Assessment of efficacy of pyridoxine in control of radiation induced sickness. J Indian Med Assoc. 1998;96:82–3.PubMedGoogle Scholar
  51. 51.
    Sahakian V, Rouse D, Sipes S, Rose N, Niebyl J. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: A randomized, double-blind placebo-controlled study. Obstet Gynecol. 1991;78:33–36.PubMedGoogle Scholar
  52. 52.
    Rodriguez-Pinilla E, Martinez-Frias ML. Corticosteroids during pregnancy and oral clefts: A case-control study. Teratology. 1998;58:2–5.PubMedCrossRefGoogle Scholar
  53. 53.
    Magee LA, Mazzotta P, Koren G. Evidence based view of safety and effectiveness of phamarcologic therapy for nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2002;186:256–61.CrossRefGoogle Scholar
  54. 54.
    Tincello DG, Johnstone MJ. Treatment of hyperemesis gravidarum with the 5-HT3 antagonist ondansetron (Zofran). Postgrad Med J. 1996;72:688–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obstet Gynecol. 1996;174:1565–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Briggs GC, Freeman RK, Yaffee SM. A reference guide to fetal and neonatal risk: Drugs in pregnancy and lactation. Philadelphia (PA): Lippincott Williams & Wilkins; 1998.Google Scholar
  57. 57.
    Ozer H, Armitage JO, Bennett CL, Crawford J, Demetri GD, Pizzo PA, et al. American Society of Clinical Oncology. 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol. 2000;18:3558–85.PubMedGoogle Scholar
  58. 58.
    Medlock ES, Kaplan DL, Cecchini M, Ulich TR, Del Castilo J, Anderson J. Granulocyte colony-stimulating factor crosses the placenta and stimulates fetal rat granulopoiesis. Blood. 1993;81:916–22.PubMedGoogle Scholar
  59. 59.
    Scott LL, Ramin SM, Richey M, Hanson J, Gilstrap LC. Erythropoietin use in pregnancy: Two cases and a review of the literature. Am J Perinatol. 1995;12:22–24.PubMedCrossRefGoogle Scholar
  60. 60.
    Sifakis S, Angelakis E, Vardaki E, Koumantaki Y, Matalliotakis I, Koumantakis E. Erythropoietin in the treatment of iron deficiency anemia during pregnancy. Gynecol Obstet Invest. 2001;51:150–6.PubMedCrossRefGoogle Scholar
  61. 61.
    FDA. Federal Register. 1980;44:37434–67.Google Scholar
  62. 62.
    Loibl S, von Minckwitz G, Gwyn K, Ellis P, Blohmer JU, Schlegelberger B, Keller M, Harder S, Theriault RL, Crivellari D, Klingebiel T, Louwen F, Kaufmann M. Breast Cancer During Pregnancy. Cancer. 2006;106:237–46.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Departments of Medicine and ResearchAmbulantes Krebszentrum Frankfurt, Germany, German Breast GroupNeu-IsenburgGermany

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