title: Cytotoxic chemotherapy for pregnancy-associated breast cancer: single institution case series.
abstract: BACKGROUND
  Pregnancy-associated (PA) breast cancer is a rare disease state that poses unique management challenges, specifically controlling the cancer and maximizing the survival of the expectant mother balanced with the health and safety of the developing fetus. As more women delay pregnancy into their 30s and 40s it is expected that this may become a more important clinical problem in the future. Existing data on PA-breast cancer comes from case series using older chemotherapy drugs. A review of practice was carried out to assess current experience with PA-breast cancer, particularly relating to current cytotoxic drugs and targeted agents.
  
  
  METHODS
  The St James's Hospital breast cancer registry, a prospectively maintained database, was used to identify cases of PA-breast cancer over a 6.5-year period and a chart review carried out. Chemotherapy administered during pregnancy, breast cancer specific outcomes, and fetal outcomes were assessed.
  
  
  RESULTS
  Five patients were identified with PA-breast cancer; median age 34 years (range 28-35). The median gestation at presentation was 18 weeks (range 14-29). Four women received chemotherapy during pregnancy; three received doxorubicin and cyclophosphamide (AC) and one paclitaxel. These agents were generally well tolerated. At median gestation of 36 weeks (range 35-40 weeks) four elective caesareans and one spontaneous delivery occurred. There were no fetal abnormalities.
  
  
  CONCLUSIONS
  Common cytotoxics can safely be delivered in pregnancy. Further research on newer therapies such as trastuzumab is needed.
authors.affiliation: Academic Unit of Clinical and Molecular Oncology, St James's Hospital, Trinity College Dublin, Ireland.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Morris
authors.forename: Fionnuala
authors.initials: F
authors.lastname: King
authors.forename: M John
authors.initials: MJ
authors.lastname: Kennedy
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016208:Databases, Factual; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy* / Q000473:pathology; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents