Pregnancy and Breast Cancer

Transcription

1 Pregnancy and Breast Cancer Page of 5 INITIAL EVALUATION Palpable mass greater than 2 weeks History and physical Bilateral mammogram with fetal shielding/ultrasound of breast and nodal basins Core biopsy Core Biopsy Pathology Ductal Carcinoma 2 In Situ (DCIS) Invasive Breast Cancer See Ductal Carcinoma In Situ Breast Cancer n-invasive Algorithm See Clinical Stages on Pages 2-3 If metastatic disease at diagnosis, individualized treatment with multidisciplinary planning 2 Patients with ductal carcinoma in situ should not receive chemotherapy.

2 Pregnancy and Breast Cancer Page 2 of 5 Clinical Stage I Surgical Consult for Primary Treatment Maternal Fetal Medicine consult to determine fetal age and delivery date Individualized care as clinically indicated: including primary surgery if preoperative chemotherapy is not indicated and if fetal age less than 23 weeks gestation at MD Anderson (MDACC) If primary surgery is necessary between 23 weeks and delivery, surgery to be performed at outside facility with complete obstetrics unit available. Pathology review: Is patient a candidate for postoperative systemic therapy? Individualized surveillance program based on clinical indication Medical Oncology Consult Systemic Therapy: Anthracycline and/or Taxane chemotherapy as medically appropriate once fetal age greater than or equal to 2 weeks Response? Maternal fetal medicine follow-up prior to each Anthracycline chemotherapy or every 3-5 weeks prior to Taxane chemotherapy Individualized therapy based on multidisciplinary conference recommendation Continue systemic therapy until completed Surveillance After delivery of baby, individualized care as clinically indicated Anthracycline therapy prior to Taxane therapy is the preference

3 Pregnancy and Breast Cancer Page 3 of 5 CLINICAL STAGES Clinical Stage II or III or suspicion of distant metastatic disease Ultrasound of liver Chest x-ray with fetal shielding MRI Thoracic/ Lumbar screening Fetal Medicine Consult to determine fetal age and delivery date Surgical consult and Medical Oncology consult to determine preferred sequencing of systemic and local therapy Surgical Resection Systemic Therapy Pathology review: Calculate Residual Disease Burden Fetal age greater than or equal to 2 weeks? Anthracycline therapy prior to taxane therapy is the preference Systemic Therapy Anthracycline and/or Taxane therapy as medically appropriate Maternal Fetal Medicine follow-up prior to each chemotherapy cycle If gestational age is 35 weeks or as recommended by Maternal Fetal Medicine - Stop chemotherapy 3 weeks prior to delivery date Individualized therapy based on multidisciplinary conference recommendation Evaluate tumor response after 6-9 weeks of Anthracycline and/or Taxane Therapy Tumor response? Continue Systemic therapy until completed, followed by Surgical Resection, followed by Radiation Therapy (after delivery of baby) Individualized therapy based on multidisciplinary conference recommendation Following the delivery of baby: Additional chemotherapy, endocrine, biologic therapy or radiation Review labor, delivery, and neonatal records Surveillance

4 Pregnancy and Breast Cancer Page 4 of 5 SUGGESTED READINGS PUBLICATIONS Peer-Reviewed Original Research Articles Amant F, Halaska MJ, Fumagalli M, et al. (204). Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting. International Journal of Gynecological Cancer,24: Doi:0.097/IGC Amant F, von Minckwitz G, Han SN, et al. (203). Prognosis of Women With Primary Breast Cancer Diagnosed During Pregnancy: Results From an International Collaborative Study. Journal of Clinical Oncology, 3: Azim Jr HA, Santoro L, Russell-Edu W, et al. (202). Prognosis of pregnancy-associated breast cancer: A meta-analysis of 30 studies. Cancer Treatment Reviews, 38: Beadle BM, Woodward WA, Middleton LP, et al. (2009). The impact of pregnancy on breast cancer outcomes in women 35 years. Cancer, 5(6): Berry DL, Theriault RL, Holmes FA, et al. (999). Multidisciplinary management of breast cancer during pregnancy: An 8 year experience using a standardized protocol. J Clin Oncol, 7: Fanale MA, Uyei AR, Theriault RL, et al. (2005). Treatment of metastatic breast cancer with trastuzumab and vinorelbine during pregnancy. Clin Breast Cancer, 6(4): Hahn KM, Johnson PH, Gordon N, et al. (2006) Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer, 07(6): Kuerer HM, Gwyn K, Ames FC, et al. (2002). Conservative surgery and chemotherapy for breast carcinoma during pregnancy. Surgery, 3():08-0. Keleher AJ, Theriault RL, Gwyn KM, et al. (2002). Multidisciplinary management of breast cancer concurrent with pregnancy. J Am Coll Surg, 94():5464. Litton J, Warneke C, Hahn K, et al. (203). Case Control Study of Women Treated with Chemotherapy for Breast Cancer During Pregnancy as Compared with n-pregnant Breast Cancer Patients. The Oncologist In press. Middleton LP, Amin M, Gwyn K, et al. (2003). Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features. Cancer, 98: Mir O, Berveiller P, Goffinet F, et al. (2009). Taxanes for breast cancer during pregnancy: a systematic review. Ann Oncol:mdp57 Murthy R, Theriault R, Barnett C, et al. (204). Outcomes of children exposed in utero to chemotherapy for breast cancer. Breast Cancer Research, 6:344. Theriault R, Hahn K. (2007). Management of Breast Cancer in Pregnancy. Curr Oncol Rep, 9:7-2. Yang WT, Dryden MJ, Gwyn K, et al. (2006). Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology, 239: Invited Articles Litton JK, Theriault RL. (200). Breast cancer and pregnancy: current concepts in diagnosis and treatment. The Oncologist,5(2): Litton JK, Theriault RL. (203). Pregnancy during or after breast cancer diagnosis: what do we know and what do we need to know? Journal of Clinical Oncology, Jul 0;3(20):252-2.

5 Pregnancy and Breast Cancer Page 5 of 5 DEVELOPMENT CREDITS This practice consensus algorithm is based on majority expert opinion of the Breast Medical Oncology Faculty at the University of Texas MD Anderson Cancer Center. It was developed using a multidisciplinary approach that included input from the following medical and surgical oncologists: Henry Mark Kuerer MD Jennifer Litton MD Vicente Valero MD