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Metastatic Breast Cancer
Center of Excellence
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Anil Goel
Jul 13, 2016
Yes. In view of pregnancy, patient should be put on NACT AC for 4 cycles and followed by BCS. After that baby should be delivered and followed by further management. Hormonal treatment and radiotherapy are contraindicated in pregnancy.
Syed Sameer Nasir
Jul 19, 2016
Gestational breast cancer is defined as diagnosis of breast cancer during pregnancy, 1st postpartum year or during lactation. As in non-pregnant women, surgery is the definitive local treatment and poses minimal fetal risk during any trimester of pregnancy.1-3 Mastectomy has the benefit that it may eliminate requirement for breast irradiation. BCS can be used effectively with delay of breast irradiation until after delivery.4-6 Sentinel lymph node biopsies (SLNB) during pregnancy is controversial7,8 and axillary lymph node dissection (ALND) is the standard approach for pregnant patients. Regarding systemic therapy, It is safe to administer most chemotherapeutic agents used in treating breast cancer during pregnancy after the first trimester. However, there is limited data regarding dose-dense schedule compared with treatment administered every three weeks.9 The latter allows for exclusion of pegfilgastim, for which there is insufficient human data to recommend administration during pregnancy. Filgrastim can be safely administered in trimester 2 and 3 if GCSF support is required. There is insufficient data on the safety of taxanes during pregnancy and therefore when possible should be delayed until delivery. References: 1. Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Arch Surg 2003; 138:91. 2. Mazze RI, Källén B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 1989; 161:1178. 3. Gianopoulos JG. Establishing the criteria for anesthesia and other precautions for surgery during pregnancy. Surg Clin North Am 1995; 75:33. 4. Kuerer HM, Gwyn K, Ames FC, Theriault RL. Conservative surgery and chemotherapy for breast carcinoma during pregnancy. Surgery 2002; 131:108. 5. Annane K, Bellocq JP, Brettes JP, Mathelin C. Infiltrative breast cancer during pregnancy and conservative surgery. Fetal Diagn Ther 2005; 20:442. 6. Dominici LS, Kuerer HM, Babiera G, et al. Wound complications from surgery in pregnancy-associated breast cancer (PABC). Breast Dis 2010; 31:1. 7. Cardonick E, Gilmandyar D, Somer RA. Maternal and neonatal outcomes of dose-dense chemotherapy for breast cancer in pregnancy. Obstet Gynecol 2012; 120:1267.
Apr 24, 2024
Pending Moderator approval.
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Sameer
Nasir
MD
Anil Goel
Jul 13, 2016
Syed Sameer Nasir
Jul 19, 2016
Apr 24, 2024
Pending Moderator approval.