Multimodality Treatment Appears Safe for Pregnant Women

PARIS--The treatment of breast cancer in pregnant women remains controversial,not least because pregnant and lactating women are traditionally excludedfrom clinical trials. Now a prospective long-term study from M.D. AndersonCancer Center suggests that multimo-dality treatment does not pose anyuntoward 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 operablebreast cancer underwent modified radical mastectomy and then received sixcourses of adjuvant FAC (5-fluorouracil, Adriamycin, cyclophosphamide).Those with locally advanced disease first received three courses of FACand then underwent surgery, followed by adjuvant FAC and comprehensiveradiation.

Surgery was performed at a median gestational age of 16 weeks, and chemotherapywas initiated at a median gestational age of 22 weeks. Diagnostic studiesincluded needle or core needle biopsy, ultrasound, and mammography, althoughbone and CT scans were avoided.

Tumor characteristics in the 30 study participants were similar to thosethat would be expected in a comparable population of young, nonpregnantwomen, Dr. Theriault said. Two thirds of tumors had invaded the lymph nodesand two thirds were estrogen-receptor negative.

Dr. Theriault reported that the median gestational age at delivery was38 weeks, with preterm deliveries limited to one case of preeclampsia andtwo 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 allhad Apgar scores of at least 9. "We had one case of hyaline membranedisease due to prematurity at the time of delivery and one infant withtransient leukopenia whose mother delivered at a time when her granulocytecount 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 importantbecause of the potential risk of teratogenicity. Beyond 20 weeks' gestation,however, the major issues become premature labor and the timing of delivery.