Tal Sella1, Pedro Exman2, Siyang Ren3, Taylor S Freret4, Katherine E Economy4, Wendy Y Chen1, Heather A Parsons1, Nancy U Lin1, Beverly Moy5, Nadine M Tung6, Ann H Partridge1, Nabihah Tayob3, Erica L Mayer7. 1. Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA. 2. Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil. 3. Data Science, Dana-Farber Cancer Institute, Boston, MA, USA. 4. Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA. 5. Medical Oncology, Massachusetts General Hospital, Boston, MA, USA. 6. Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 7. Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA. emayer@partners.org.
Abstract
BACKGROUND: Guidelines support comparable treatment for women diagnosed with breast cancer during pregnancy (PrBC) and nonpregnant women with limited case-specific modifications to ensure maternal-fetal safety. Experience during pregnancy with modern agents, such as taxanes or granulocyte colony-stimulating factors (GCSF), is limited. PATIENTS AND METHODS: We retrospectively identified a multi-institutional cohort of PrBC between 1996 and 2020. Propensity score analyses with multiple imputation for missing variables were applied to determine the associations between chemotherapy exposures during pregnancy, with or without taxanes or GCSF, and a compound maternal-fetal outcome including spontaneous preterm birth, preterm premature rupture of membranes, chorioamnionitis, small for gestational age newborns, congenital malformation, or 5-min Apgar score < 7. RESULTS: Among 139 PrBC pregnancies, 82 (59.0%) were exposed to chemotherapy, including 26 (31.7%) to taxane and 18 (22.0%) to GCSF. Chemotherapy use, in general, and inclusion of taxane and/or GCSF, specifically, increased over time. Pregnancies resulting in live singleton births (n = 123) and exposed to chemotherapy were as likely to reach term as those that were not (59.5% vs. 63.6%, respectively, punadjusted = 0.85). Among women treated with chemotherapy, propensity score-matched odds ratios (OR) for the composite maternal-fetal outcome were not significantly increased with taxane (OR 1.24, 95% CI 0.27-5.72) or GCSF (OR 2.11, 95% confidence interval (CI) 0.48-9.22) with similar effects in multiple imputation and sensitivity models. CONCLUSION: The judicious increased use of taxane chemotherapy and/or growth factor support during pregnancy was not associated with unfavorable short-term maternal-fetal outcomes. While these findings are reassuring, case numbers remain limited and continued surveillance of these patients and progeny is warranted.
BACKGROUND: Guidelines support comparable treatment for women diagnosed with breast cancer during pregnancy (PrBC) and nonpregnant women with limited case-specific modifications to ensure maternal-fetal safety. Experience during pregnancy with modern agents, such as taxanes or granulocyte colony-stimulating factors (GCSF), is limited. PATIENTS AND METHODS: We retrospectively identified a multi-institutional cohort of PrBC between 1996 and 2020. Propensity score analyses with multiple imputation for missing variables were applied to determine the associations between chemotherapy exposures during pregnancy, with or without taxanes or GCSF, and a compound maternal-fetal outcome including spontaneous preterm birth, preterm premature rupture of membranes, chorioamnionitis, small for gestational age newborns, congenital malformation, or 5-min Apgar score < 7. RESULTS: Among 139 PrBC pregnancies, 82 (59.0%) were exposed to chemotherapy, including 26 (31.7%) to taxane and 18 (22.0%) to GCSF. Chemotherapy use, in general, and inclusion of taxane and/or GCSF, specifically, increased over time. Pregnancies resulting in live singleton births (n = 123) and exposed to chemotherapy were as likely to reach term as those that were not (59.5% vs. 63.6%, respectively, punadjusted = 0.85). Among women treated with chemotherapy, propensity score-matched odds ratios (OR) for the composite maternal-fetal outcome were not significantly increased with taxane (OR 1.24, 95% CI 0.27-5.72) or GCSF (OR 2.11, 95% confidence interval (CI) 0.48-9.22) with similar effects in multiple imputation and sensitivity models. CONCLUSION: The judicious increased use of taxane chemotherapy and/or growth factor support during pregnancy was not associated with unfavorable short-term maternal-fetal outcomes. While these findings are reassuring, case numbers remain limited and continued surveillance of these patients and progeny is warranted.
Authors: Rebecca H Johnson; Carey K Anders; Jennifer K Litton; Kathryn J Ruddy; Archie Bleyer Journal: Pediatr Blood Cancer Date: 2018-08-28 Impact factor: 3.167
Authors: Frédéric Amant; Gunter von Minckwitz; Sileny N Han; Marijke Bontenbal; Alistair E Ring; Jerzy Giermek; Hans Wildiers; Tanja Fehm; Sabine C Linn; Bettina Schlehe; Patrick Neven; Pieter J Westenend; Volkmar Müller; Kristel Van Calsteren; Brigitte Rack; Valentina Nekljudova; Nadia Harbeck; Michael Untch; Petronella O Witteveen; Kathrin Schwedler; Christoph Thomssen; Ben Van Calster; Sibylle Loibl Journal: J Clin Oncol Date: 2013-04-22 Impact factor: 44.544