TITLE

Adjuvant breast cancer chemotherapy during late-trimester pregnancy: not quite a standard of care

AUTHOR(S)
Epstein, Richard J.
PUB. DATE
January 2007
SOURCE
BMC Cancer;2007, Vol. 7, p92
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Diagnosis of breast cancer during pregnancy was formerly considered an indication for abortion. The pendulum has since swung to the other extreme, with most reviews now rejecting termination while endorsing immediate anthracycline-based therapy for any pregnant patient beyond the first trimester. To assess the evidence for this radical change in thinking, a review of relevant studies in the fields of breast cancer chemotherapy, pregnancy, and drug safety was conducted. Discussion: Accumulating evidence for the short-term safety of anthracycline-based chemotherapy during late-trimester pregnancy represents a clear advance over the traditional norm of therapeutic abortion. Nonetheless, the emerging orthodoxy favoring routine chemotherapy during gestation should continue to be questioned on several grounds: (1) the assumed difference in maternal survival accruing from chemotherapy administered earlier — i.e., during pregnancy, rather than after delivery — has not been quantified; (2) the added survival benefit of adjuvant cytotoxic therapy prescribed within the hormone-rich milieu of pregnancy remains presumptive, particularly for ER-positive disease; (3) the maternal survival benefit associated with modified adjuvant regimens (e.g., weekly schedules, omission of taxanes, etc.) has not been proven equivalent to standard (e.g., post-delivery) regimens; and (4) the long-term transplacental and transgenerational hazards of late-trimester chemotherapy are unknown. Summary: Although an incrementally increased risk of cancer-specific mortality is impossible to exclude, mothers who place a high priority on the lifelong well-being of their progeny may be informed that deferring optimal chemotherapy until after delivery is still an option to consider, especially in ER-positive, node-negative and/or last-trimester disease.
ACCESSION #
29337020

 

Related Articles

  • Comparison of elapsed times from breast cancer detection to first adjuvant therapy in Nova Scotia in 1999/2000 and 2003/04. Rayson, Daniel; Saint-Jacques, Nathalie; Younis, Tallal; Meadows, Jason; Dewar, Ron // CMAJ: Canadian Medical Association Journal;1/30/2007, Vol. 176 Issue 3, p327 

    Background: Waiting times for cancer care continue to be an important issue for Canadians. We evaluated 2 cohorts of breast cancer patients to compare changes in elapsed times to care, to determine the proportion of patients who received their postoperative oncology consultation within the...

  • Intersection of cardiology and oncology clinical practices. Mookadam, Farouk; Sharma, Ashwini; Lee, Howard R.; Northfelt, DonaldW. // Frontiers in Oncology;Sep2014, Vol. 4, p1 

    The article discusses cancer disease, gives statistics about incidence of cancer globally and cancer therapies. Topics include anthracycline cardiotoxicity risk for breast cancer patients, chemotherapeutic agents and toxicity detection. Anti-cancer drugs, radiation therapy and cardiovascular...

  • Adjuvant trastuzumab in the treatment of her-2-positive early breast cancer: a meta-analysis of published randomized trials. Viani, Gustavo A; Afonso, Sergio L.; Stefano, Eduardo J.; De Fendi, Ligia I.; Soares, Francisco V. // BMC Cancer;2007, Vol. 7, p153 

    Background: Breast cancer is the most common cancer in women in the U.S. and Western Europe. Amplification of the her-2/neu gene occurs in approximately 25% of invasive ductal carcinomas of the breast. The first HER-2/neu-targeted approach to reach the clinic was trastuzumab, a humanized...

  • Trial on Refinement of Early stage non-small cell lung cancer. Adjuvant chemotherapy with pemetrexed and cisplatin versus vinorelbine and cisplatin: The TREAT protocol. Kreuter, Michael; Vansteenkiste, Johan; Griesinger, Frank; Hoffmann, Hans; Dienemann, Hendrik; De Leyn, Paul; Thomas, Michael // BMC Cancer;2007, Vol. 7, p77 

    Background: Adjuvant chemotherapy has been proven to be beneficial for patients with early stage non-small cell lung cancer. However, toxicity and insufficient dose delivery have been critical issues with the chemotherapy used. Doublet regimens with pemetrexed, a multi-target folate inhibitor,...

  • OP66 Tumor Profiling Tests In Early Breast Cancer: A Systematic Review. Harnan, Susan; Cooper, Katy; Stevens, John; Wong, Ruth; Tappenden, Paul; Bessey, Alice; Ward, Sue; Rafia, Rachid; Stein, Rob; Brown, Janet // International Journal of Technology Assessment in Health Care;2018 Supplement, Vol. 34, p24 

    Introduction: Tumor profiling tests can help to identify whether women with breast cancer need chemotherapy due to their risk of relapse, and some may be able to predict benefit from chemotherapy. We focused on four genetic tests: Oncotype DX (O-DX), MammaPrint (MMP), EndoPredict and Prosigna,...

  • The Faith to Survive. LOGAN, MICH A // Guideposts;Oct2015, Vol. 70 Issue 8, p44 

    A personal narrative is presented in which the author shares the experiences of her treatment of breast cancer with chemotherapy.

  • Impact of immunohistochemistry-based molecular subtype on chemosensitivity and survival in Hispanic breast cancer patients following neoadjuvant chemotherapy. Gómez, Rodolfo; Ossa, Carlos Andrés; Montoya, María Elvira; Echeverri, Carolina; Ángel, Gonzalo; Ascuntar, Johana; Borrero, Mauricio; Gil, Mónica; Herrera, Sabrina; Gutiérrez, Eduardo; Herazo, Fernando; Jiménez, Alejo; Madrid, Jorge; Reyes, Pedro Alejandro; Zuluaga, Lina; García, Héctor // Ecancermedicalscience;2015, Vol. 9 Issue 549-576, p1 

    Background: Neoadjuvant chemotherapy (NAC) is the standard treatment for patients with locally advanced breast cancer, showing improvement in disease-free survival (DFS) and overall survival (OS) rates in patients achieving pathological complete response (pCR). The relationship between...

  • INCIDENCES, SCREENING AND CHEMOTHERAPY OF BREAST CANCER. Khaliq, Sheikh Abdul; Naqvi, Syed Baqir S.; Fatima, Anab // International Journal of Pharmacy;2013, Vol. 3 Issue 4, p705 

    Retrospective study in different ethnic groups determines the burden and patterns of breast cancers during the last eight years reported in Oncology wards of hospitals of Karachi, Pakistan and compares the pharmacotherapy/chemotherapy used with international guidelines, develops strategies for...

  • The Facilitating Role of Chemotherapy in the Palliative Phase of Cancer: Qualitative Interviews with Advanced Cancer Patients. Buiting, Hilde M.; Terpstra, Wim; Dalhuisen, Floriske; Gunnink-Boonstra, Nicolette; Sonke, Gabe S.; Hartogh, Govert den // PLoS ONE;Nov2013, Vol. 8 Issue 11, p1 

    Objective: To explore the extent to which patients have a directing role in decisions about chemotherapy in the palliative phase of cancer and (want to) anticipate on the last stage of life. Design: Qualitative interview study. Methods: In depth-interviews with 15 patients with advanced...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics