Annals of Oncology Advance Access originally published online on October 5, 2007
Annals of Oncology 2008 19(4):607-613; doi:10.1093/annonc/mdm460
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Emerging therapeutic options for breast cancer chemotherapy during pregnancy
1 Department of Medical Oncology
2 Department of Clinical Pharmacology
3 Department of Obstetrics, Université Paris Descartes—Faculté de Médecine, Hôpital Cochin, Assistance Publique—Hôpitaux de Paris, Paris
4 Department of Obstetrics, Hôpital André Mignot, Versailles, France
* Correspondence to: Dr O. Mir, Department of Medical Oncology, Université Paris Descartes—Faculté de Médecine, Hôpital Cochin, Assistance Publique—Hôpitaux de Paris, 27, rue du faubourg Saint-Jacques, 75679 Paris cedex 14, France. Tel: +33-630-739-079; Fax: +33-158-411-745; E-mail: olivier.mir{at}cch.aphp.fr
Background: Breast cancer is the commonest solid tumor observed during pregnancy. Anthracycline-based chemotherapy is feasible during the 2nd and 3rd trimesters of pregnancy, but few data are available on recent and highly active drugs taxanes, vinorelbine and anti-HER-2 agents in this setting.
Patients and methods: We carried out a comprehensive review of reports documenting the use of taxanes, vinorelbine, trastuzumab and lapatinib during pregnancy in the English literature, in order to evaluate their safety profile in pregnant patients.
Results: Twenty-four pregnancies are described, in which no grade 3–4 maternal toxicity nor malformation in the offspring was reported. Whereas only one report studied the pharmacokinetics of paclitaxel (Taxol) during pregnancy, several preclinical reports indicate that the placental P-glycoprotein could prevent the transplacental transfer of taxanes and vinorelbine. The use of trastuzumab was associated with the occurrence of anhydramnios in three of six cases.
Conclusion: The administration of recent drugs taxanes and vinorelbine seems feasible during the 2nd and 3rd trimesters of pregnancy, with a favorable toxicity profile. In contrast, anti-HER-2 agents may obscure the normal development of the fetal kidney, and should be avoided during pregnancy.
Key words: breast cancer, docetaxel, paclitaxel, pregnancy, vinorelbine
Received for publication August 10, 2007. Revision received August 16, 2007. Accepted for publication August 21, 2007.
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