Tamoxifen as systemic treatment of advanced breast cancer during pregnancy- Case report and literature review

Background. When patients with metastatic breast cancer become pregnant, ma nagement is complicated by the potential harms of drug treatment to the fet us and by the potential effects of the pregnancy on the cancer. Chemotherap y is considered optimal systemic anti-cancer therapy from the second trimes ter, while tamoxifen has been considered inappropriate due to concerns over possible teratogenesis and lack of efficacy. Case. We report a patient who became pregnant concurrent with the identific ation of metastatic breast cancer and who elected to continue her pregnancy with tamoxifen as sole systemic anticancer therapy. The pregnancy was diff icult, but a normal child was delivered and the mother responded to subsequ ent hormone manipulation. The putative teratogenic effects of tamoxifen and the mechanisms underlying tamoxifen resistance in this setting are discuss ed. Conclusions. The use of tamoxifen in pregnancy is complex, but is not neces sarily associated with fetal harm and may be considered a therapeutic optio n in selected cases, (C) 2001 Academic Press.