Management of breast cancer during pregnancy using a standardized protocol

Purpose: No standardized therapeutic interventions have been reported for p atients diagnosed with breast cancer during pregnancy. Of the potential int erventions, none have been prospectively evaluated for treatment efficacy i n the mother or safety for the fetus. We present our experience with the us e of combination chemotherapy for breast cancer during pregnancy. Patients and Methods: During the past 8 years, 24 pregnant patients with pr imary or recurrent cancer of the breast were managed by outpatient chemothe rapy, surgery, or surgery plus radiation therapy as clinically indicated. T he chemotherapy included fluorouracil (1,000 mg/m(2)), doxorubicin (50 mg/m (2)), and cyclophosphamide (500 mg/m(2)), administered every 3 to 4 weeks a fter the first trimester of pregnancy. Care was provided by medical ancolog ists, breast surgeons, and perinatal obstetricians. Results: Modified radical mastectomy was performed in 18 of the 22 patients , and two patients were treated with segmental mastectomy with postpartum r adiation therapy. This group included patients in all trimesters of pregnan cy. The patients received a median of four cycles of combination chemothera py during pregnancy. No antepartum complications temporally attributable to systemic therapy were noted. The mean gestational age at delivery was 38 w eeks. Apgar scores, birthweights, and immediate postpartum health were repo rted to be normal for all of the children. Conclusion: Breast cancer can be treated with chemotherapy during the secon d and third trimesters of pregnancy with minimal complications of labor and delivery. (C) 1999 by American Society of Clinical Oncology.