Oct 5, 2010

Breast Cancer Treatment Safe, Effective During Pregnancy

NEW YORK/Reuters Health-Pregnant women with breast cancer treated with standard chemotherapy do just as well as non-pregnant patients, according to a report this week at the American Society of Clinical Oncology 2010 Breast Cancer Symposium in Washington, DC.

According to Dr. Jennifer Litton at the University of Texas MD Anderson Cancer Center, oncologists have successfully treated pregnant breast cancer patients there since the late 1980s. Unlike other physicians, they didn’t insist that the women undergo an abortion, delay treatment until after delivery, or use less than the most effective treatment regimens.

“Even today, women are advised to terminate their pregnancies before undergoing treatment for breast cancer,” Dr. Litton told Reuters Health.

Dr. Litton’s group compared outcomes for 75 women treated for breast cancer during their second or third trimester of pregnancy with 150 non-pregnant breast cancer patients, all treated at their institution between 1989 and 2008. The investigators matched cases and controls for tumor stage (I, II or III), age, and year of diagnosis.

All women were treated with 5-fluorouracil, doxorubicin and cyclophosphamide (FAC). Both groups received additional treatments as clinically indicated – taxanes, trastuzumab, and endocrine therapy – although pregnant women received these latter treatments after delivery. Investigators followed the patients for a median of 4.16 years.

The estimated five-year disease-free survival was 73.9% in pregnant women and 55.8% in nonpregnant women (p < 0.05). Overall five-year survival was comparable at 77.4% and 71.9%, respectively.

“The most important thing is that pregnant women did no worse when treated with standard of care chemotherapy than nonpregnant women,” Dr. Litton said. All infants were born alive at a median gestational age of 37 weeks.

As to the significantly better disease-free survival, she said, “we plan to actively look at that to see if there is something biological going on. Maybe something about pregnancy sensitizes the tumor to chemotherapy.”

She and her associates also plan to follow the moms long term, as well as the children exposed in utero to chemotherapy. This will be particularly important since breast cancer during pregnancy is expected to become more common as women delay childbearing into their 30s and even 40s.

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