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.
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Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Berkowitz GS, Skovron ML, Lapinski RH, Berkowitz RL (1990) Delayed childbearing and the outcome of pregnancy. N Engl J Med 322:639–664
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
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
Boldrini R, Di Cesare M, Tamburini C (eds) (2007) Rapporto CeDAP, 2004. Italian Ministry of Health website (www.ministerosalute.it)
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
Cardonick E, Iacobucci A (2004) Use of chemotherapy during human pregnancy. Lancet Oncol 5:283–291. doi:10.1016/S1470-2045(04)01466-4
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
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
Doll DC, Ringenberg QS, Yarbo JW (1989) Antineoplastic agents and pregnancy. Semin Oncol 16:337–346
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
Barthelmes L, Davidson LA, Gaffney C, Gateley CA (2005) Pregnancy and breast cancer. BMJ 330:1375–1378. doi:10.1136/bmj.330.7504.1375
Bonadonna G, Gianni L, Santoro A, Bonfante V, Bidoli P, Casali P et al (1993) Drugs ten years later: epirubicin. Ann Oncol 4:359–369
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 60:938–941
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
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 17–30
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
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
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
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
Kushari J, Mukherjea M (1980) Studies on beta-glucuronidase of the developing human placenta. Gynecol Obstet Invest 11:119–127
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
Partridge AH, Garber JE (2000) Long-term outcomes of children exposed to antineoplastic agents in utero. Semin Oncol 27:712–726
Gwyn K (2005) Children exposed to chemotherapy in utero. J Natl Cancer Inst Monogr 34:69–71. doi:10.1093/jncimonographs/lgi009
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
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Fedro A. Peccatori and Hatem A. Azim Jr contributed equally to the work.
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Peccatori, F.A., Azim, H.A., Scarfone, G. et al. Weekly epirubicin in the treatment of gestational breast cancer (GBC). Breast Cancer Res Treat 115, 591–594 (2009). https://doi.org/10.1007/s10549-008-0159-2
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DOI: https://doi.org/10.1007/s10549-008-0159-2