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(Drug information on cyclophosphamide)). Those with locally advanced disease first received three courses of FAC and then underwent surgery, followed by adjuvant FAC and comprehensive radiation.
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.