Treatment of pregnancy-associated breast cancer
Frauenklinik der Heinrich Heine Universität, Dusseldorf, Germany. . Expert Opinion on Pharmacotherapy
(Impact Factor: 3.53).
09/2009; 10(14):2259-67. DOI: 10.1517/14656560903168906
In primary breast cancer three therapeutic components-cytotoxic, endocrine and targeted antibody therapy-have led to a significant reduction in breast cancer mortality. In pregnancy associated breast cancer the right therapeutic choice is still under discussion while incidence is increasing. With an incidence of 1/3,000 to 1/10,000 pregnancies, pregnancy-associated breast cancer is the most common solid tumor in pregnancy after cervical carcinoma.
This article reviews the evidence base for the use of various treatment modalities in patients with pregnancy-associated breast cancer.
Medline review, searching for articles including years 2000 through 2008 was performed. Search was conducted for the terms "pregnancy" and "breast cancer". Cross references up to the second level were taken into account if of interest for this review.
Loco-regional therapy of pregnancy-associated breast cancer follows the general guidelines for breast cancer therapy in principle. Radiation of the breast and/or chest wall is usually not performed during pregnancy. Chemotherapy is indicated for the majority of patients with pregnancy-associated breast cancer. After the first trimester, anthracycline-based chemotherapy is regarded as the treatment standard in pregnancy. Folate antagonists such as methotrexate are strictly contraindicated as they are the main cause of fetal malformations. Adjuvant endocrine therapy with anti-estrogens during pregnancy is contraindicated. Data on targeted biological treatment, particularly for HER2/neu positive tumors during pregnancy are scarce and this treatment should be postponed until after delivery.
This article summarizes the special features of the diagnosis and primary therapy of pregnancy-associated breast cancer with particular emphasis on cytotoxic therapy.
Available from: Eray Caliskan
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ABSTRACT: Breast cancer is one of the most common cancers diagnosed during pregnancy and its frequency is increasing as more women postpone their pregnancies to their thirties and forties. Breast cancer diagnosis during pregnancy and lactation is difficult and complex both for the patient and doctors. Delay in diagnosis is frequent and treatment modalities are difficult to accept for the pregnant women. The common treatment approach is surgery after diagnosis, chemotherapy after the first trimester and radiotherapy after delivery. Even though early stage breast cancers have similar prognosis, advanced stage breast cancers diagnosed during pregnancy and lactation have poorer prognosis than similar stage breast cancers diagnosed in non-pregnant women. Women who desire to become pregnant after treatment of breast cancer will have many conflicts. Although the most common concern is recurrence of breast cancer due to pregnancy, the studies conducted showed that pregnancy has no negative effect on breast cancer prognosis. In this review we search for the frequency of breast cancer during pregnancy, the histopathological findings, risk factor, diagnostic and treatment modalities. We reviewed the literature for evidence based findings to help consult the patients on the outcome of breast cancer diagnosed during pregnancy and lactation, and also inform the patients who desire to become pregnant after breast cancer according to current evidences.
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ABSTRACT: Cancer is the second leading cause of death among women of reproductive age. Although the coincidence of pregnancy and cancer is rare and treatment may sometimes be safely delayed, the use of chemotherapeutic agents in pregnancy is sometimes unavoidable or inadvertent.
We review the literature for the use of antineoplastic agents in single-agent and combination therapy from 1951 through June 2012. We also summarize the evidence relating to teratogenicity of disorder-specific combination chemotherapy treatments for those malignancies frequently encountered in women of childbearing age. Major endpoints were called "adverse pregnancy outcomes" (APOs), to include structural anomalies (congenital malformations), functional defects, blood or electrolyte abnormalities, stillbirths, spontaneous abortions (miscarriages), and fetal, neonatal, or maternal deaths.
The registry totals 863 cases. Rates of APOs (and congenital malformations) after any exposure were 33% (16%), 27% (8%), and 25% (6%), for first, second, and third trimesters. Among the groups of cancer drugs, antimetabolites and alkylating agents have the highest rates of APOs. Mitotic inhibitors and antibiotics seem more benign. Mixed results were observed from single-agent exposure, often because of small numbers of exposures. As a whole, the alkylating agents and antimetabolites are more harmful when given as a single agent rather than as part of a regimen. First-trimester exposure poses a more permanent risk to the fetus.
Systematic ascertainment of women early in pregnancy, preferably in a population base, is needed for assessment of true risks. Long-term follow-up is needed to rule out neurobehavioral effects.
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ABSTRACT: Extracellular signal-regulated kinase (ERK1/2) is implicated in the malignant behavior of breast cancer cells. However, previous clinical-pathological studies have shown that expression of activated/phosphorylated ERK1/2 is not associated with enhanced proliferation and invasion of mammary carcinomas. ERK1/2 is expressed in the cytoplasm, and activated/phosphorylated ERK1/2 translocates to the nucleus. The aim of this study is to evaluate nuclear phosphorylated ERK1/2 as a biomarker for breast cancer prognosis. The clinical-pathological relation of cytoplasmic/nuclear phosphorylated ERK1/2 was analyzed in 105 surgically resected breast cancer specimens by immunohistochemistry with tissue microarray. The results showed that non-neoplastic breast tissue mainly showed faint phosphorylated ERK1/2 staining. No statistically significant association was found between the level of cytoplasmic phosphorylated ERK1/2 expression and the clinical features of the disease. High nuclear phosphorylated ERK1/2 expression was associated with high grade (poor differentiation, p = = 0.010), high T status (larger tumor size, p = 0.033), and an advanced stage (p = 0.018) of the disease. Thus, nuclear phosphorylated ERK1/2 is associated with enhanced proliferation and invasion of mammary carcinomas and may be a biomarker for breast cancer prognosis and the determination of therapeutic strategies.
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