PARIS--The treatment of breast cancer in pregnant women remains controversial,
not least because pregnant and lactating women are traditionally excluded
from clinical trials. Now a prospective long-term study from M.D. Anderson
Cancer Center suggests that multimo-dality treatment does not pose any
untoward threat to either mother or child.
In his report at the Seventh International Congress on Anti-Cancer Treatment
(ICACT), Richard Theriault, MD, said that pregnant patients with operable
breast cancer underwent modified radical mastectomy and then received six
courses of adjuvant FAC (5-fluorouracil, Adriamycin, cyclophosphamide).
Those with locally advanced disease first received three courses of FAC
and then underwent surgery, followed by adjuvant FAC and comprehensive
Surgery was performed at a median gestational age of 16 weeks, and chemotherapy
was initiated at a median gestational age of 22 weeks. Diagnostic studies
included needle or core needle biopsy, ultrasound, and mammography, although
bone and CT scans were avoided.
Tumor characteristics in the 30 study participants were similar to those
that would be expected in a comparable population of young, nonpregnant
women, Dr. Theriault said. Two thirds of tumors had invaded the lymph nodes
and two thirds were estrogen-receptor negative.
Dr. Theriault reported that the median gestational age at delivery was
38 weeks, with preterm deliveries limited to one case of preeclampsia and
two cases of premature labor. "According to our obstetrician colleagues,
this is not an excessive rate," he noted.
None of the infants were born with congenital malformations, and all
had Apgar scores of at least 9. "We had one case of hyaline membrane
disease due to prematurity at the time of delivery and one infant with
transient leukopenia whose mother delivered at a time when her granulocyte
count was zero," he said. Over a median follow-up period of four years,
all of the children have reached normal developmental milestones.
For women diagnosed as having breast cancer at less than 20 weeks' gestation,
Dr. Theriault said, genetic and termination counseling may be important
because of the potential risk of teratogenicity. Beyond 20 weeks' gestation,
however, the major issues become premature labor and the timing of delivery.