American Journal of Therapeutics | 2021
Doxorubicin- and Cyclophosphamide-Based Chemotherapy for Pregnant Women With Stage IIIa Breast Cancer.
Abstract
To the Editor: In Japan, the number of breast cancer patients each year is around 82,000, with cases peaking in the late forties to early fifties age group.1 The occurrence of breast cancer during pregnancy has been reported to be approximately one in 2000 women. Standard chemotherapy is recommended when treating nonpregnant women. However, the clinical course of cancer chemotherapy for pregnant women is not well reported.2,3 Hence, we present a case of a pregnant woman with breast cancer, who underwent chemotherapy. A 40-year-old woman noted a lump in her left breast at the 11th week of gestation and was diagnosed with hormone-receptor-positive HER2-positive breast cancer. After discussing termination, she and her spouse chose to continue the pregnancy. She underwent total mastectomy and axillary lymph node dissection at the 18th week of gestation. The diagnosis and histopathological stage was breast cancer pT2N3aM0 pStage IIIa. No evidence of distant metastasis was found on imaging tests without radiation exposure. Therefore, chemotherapy for this patient was approved by the Institute Reviewer Board and the Cancer Board at Showa University Koto Toyosu Hospital, and consent from the patient and her spouse was obtained. We selected the treatment regimen according to the National Comprehensive Cancer Network guidelines. Four courses of doxorubicin and cyclophosphamide therapy, including doxorubicin (60 mg/m2 every 3 weeks) and cyclophosphamide (600 mg/m2 every 3 weeks), were administered.3 We selected antiemesis drugs considering passage for the placenta. We gave 4 mg of ondansetron and 140 mg of prednisolone (iv) on day 1, as well as 50 mg on days 2 and 3 (po) for chemotherapy-induced nausea. AC therapy was initiated since the 25th weeks of gestation. During therapy, grade 1 nausea and grade 2 alopecia were the only noted adverse events (Figure 1). Her body weight gain was within the normal range throughout the treatment period (45–53 kg). Liver and kidney functions remained within the normal range (aspartate aminotransferase/alanine aminotransferase: 17/9 IU, blood urea nitrogen/creatinine 6.9/0.46 mg/ dL). Supporting medication therapy of famotidine (40 mg/d), hochu-ekki-to (7.5 g/d), and probiotics did not change throughout the periods. Complications associated with pregnancy, such as gestational hypertension, were not observed. At the 38th weeks of gestation, just before delivery, blood tests showed grade 1 neutropenia (1878/mL), but there were no symptoms suggestive of infection. We performed delivery according to the treatment plan. The program delivery section was performed at 38th weeks of gestation. The baby was a 2934 g male infant with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. The noted body weights 1 and 2 months after birth were 3700 and 4225 g. One year after birth, developmental problems, including cardiac function, have not been observed. Our maternal case made an untroubled recovery after delivery and has continued to receive systemic drug therapy for breast cancer without suspicious symptoms of recurrence. In general, the conflict between delivery and cancer is fatal and may be accompanied by drastic changes in mental conditions. However, the information on pregnant women with cancer is insufficient. The clinical outcomes for pregnant breast cancer patients were reportedly similar to those of breast cancer patients who were not pregnant.4–6 Case conferences held by multidisciplinary professional medical staff, such as doctors for treatment policy, pharmacists for treatment regimens and supportive therapy, and nurses for mental care play an essential role, especially in the case mentioned above. In particular, pharmacists need to consider placental permeability and administration planning in the clinical setting. Medical staff need to collaborate to provide better care when managing pregnant cancer patients. American Journal of Therapeutics 0, 1–3 (2020)