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Heilung durch Innovation, Kompetenz und Partnerschaft

Breast cancer during pregnancy

a prospective and retrospective registry

(GBG-20 / BIG02-03)

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Breast cancer is the most common cancer malignancy in womenof childbearing age after the age of 25 years.

About 3% of all breast cancers are diagnosed during pregnancy.[1]

Pregnancy has a dual effect on the risk of breast cancer: ittransiently increases the risk after childbirth but reduces the riskin later years. [2]

The MD Anderson Cancer Centre developed a protocol for the

management of breast cancer in pregnancy and demonstratedthat it is safe to treat them according to the current standard.[3]

The 5-year survival rate of patients with negative axillary lymphnodes is 82% in both pregnant and non-pregnant women and 59%in node-positive patients. [4]

[1] Nulman et al. Neurodevelopment of children exposed in utero to treatment of maternal malignancy. Br J Cancer 6 (2001) 1611-18.

[2] Lambe et al. Transcient increase in the risk of breast cancer after giving birth. N Engl J Med 331 (1994) 5-9.[3] Loibl et al. Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer 106 (2006) 237-246.

[4] Petrek JA, Dukoff R, Rogatko A. Prognosis of pregnancy-associated breast cancer. Cancer 67 (1991) 869-872.

Background:

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0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

A p r .

0 3

S e p .

0 3

F e b .

0 4

J u l.

0 4

D e z .

0 4

M a i.

0 5

O k t .

0 5

M r z .

0 6

A u g .

0 6

J a n .

0 7

J u n .

0 7

N o v .

0 7

A p r .

0 8

S e p .

0 8

accrualno.

From April 2003 - April 2008, 141 patients have been registered.

The median age is 33 years (range 24-43 years).

Recruitment

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Patients characteristics (n=134):

T T1 24.6%

T2 47.4%

T3 20.2%

T4 7.9%

N N- 32.7%

N+ 67.3%

M M0 79.0%

M1 8.0%

Mx 13.0%

ER/PR Negative 56.4%

Positive 43.6%

Her-2/neu

Positive 57.3%

Negative 42.7%

Grading

1 1.9%

2 27.2%

3 70.9%

Histo type

Ductal invasive 83.8%

Lobular invasive 4.5%

Inflammatory 5.4%

Other 6.3%

Chemotherpy during pregnancy

Surgery and chemotherpy 41.8%

Syrgery only 31.1%

Chemotherapy only 4.9%

No therapy 3.3%

Therapy unknow 18.9%

Chemotherpy after pregnancy

Chemotherapy only 26.2%

Delivery

Spontaneous delivery 35.3%

Operative vaginal delivery 13.7%

Caessarean Sectio 51.0%

20% of all patients have been diagnosed during the 1st, 43.8% during the 2nd and 36.2% during the3rd trimester.

The median time of delivery was 37 weeks (range 31-41 weeks).

The median weight of babies, whose mother received systemic therapy, was 2740 g (range 1270-

3740),the median weight of babies without cytotoxic therapy during pregnancy was 2723 g (range

1260-4180).

The APGAR-Score was not reduced.

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Cytotoxic regimes during

pregnancy (n=57):

Regimen 6 x AC/EC 4 x AC/EC

4 x AC/EC

followed by

texane

3 x CMF

followed by

4 x EC

6 x FEC 6 x CMF

N 15 7 15 2 7 11

The 57 patients evaluable received in the median 4 cycles during pregnancy (1-7).

The maximum given was 7 cycles. No significant differences in postpartumhaemoglobin were documented.

The median haemoglobin in babies received intrauterine systemic treatment was16.7 g/dl (range 10.4-24.9) and 16.9 g/dl (range 13.7-21.4) in babies withoutintrauterine chemotherapy.

Maternal outcome: By April 2008 32 patient relapsed.

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Pregnant women with breast cancer need to be treated ina specialized team.

Systemic cytotoxic treatment after the 12th gestational

week is feasible.

Fetal outcome in babies, who received intrauterinechemotherapy was not different from those who did not.

Registry needs to be continued to get more validprospective information.

Conclusion: