Case report
Multimodal cancer chemotherapy during the first and second trimester of pregnancy: a case report

https://doi.org/10.1016/S0301-2115(99)00240-7Get rights and content

Abstract

This paper reports treatment with combined chemotherapy during pregnancy. A 39-year-old woman with breast cancer was given adjuvant chemotherapy including cyclophosphamide, methotrexate and 6-fluorouracil from the 6th to the 24th week of gestation. The possibility of teratogenic effects on the fetus was explained to the patient however she refused to terminate the pregnancy. A 30-week male infant with only a minor malformation was delivered. The authors reviewed the literature regarding chemotherapeutic agents given during the first trimester of pregnancy. Most cytotoxic drugs have teratogenic effects on experimental animal subjects. However, actual data on human fetuses are sparse because of the variety of therapeutic regimens and the rarity of administering chemotherapy during pregnancy. The long-term effects of exposure to cytotoxic drugs in utero, needs further research.

Introduction

The simultaneous occurrence of breast cancer and pregnancy is infrequent occurring in 10–30 patients per 100 000 pregnancies [1]. This coincidence raises questions about the management of the mother and her disease on the one hand and the management of the fetus on the other. Chemotherapy and radiation therapy during pregnancy may cause fetal malformation, low birth weight and long-term carcinogenesis. The teratogenicity of antineoplastic agents has been shown in experiments on animals [2], [3] Similar phenomena can be seen in human fetuses when such drugs are administered during the first trimester of pregnancy [2]. Alkylating agents, especially cyclophosphamide, on administration during the first trimester of pregnancy, have been associated with the appearance of major and minor abnormalities [3]. Antimetabolites including methotrexate are also reported to cause teratogenic effects on the fetus or even abortion [2]. Yet, due to the rarity of the use of chemotherapy in pregnancy and the variety of therapeutic regimens, actual data are sparse.

This is a case of a 39-year-old woman who received combined chemotherapy during the first and second trimester of pregnancy and delivered a premature infant, with only a slight malformation, an inguinal hernia.

Section snippets

Case report

A 39-year-old woman with no prior pregnancies, presented with a nodule in the right breast. A biopsy of the nodule revealed an infiltrating duct carcinoma and a modified radical mastectomy was performed. Twenty-one of twenty-three axillary lymph nodes were involved with the carcinoma. The patient started adjuvant chemotherapy, including cyclophosphamide, methotrexate and 5-fluorouracil, 20 days later. After the fifth cycle of treatment (4 months later) the patient complained of abdominal

Discussion

Cytotoxic agents are minimally selective and usually affect rapidly proliferating cells, such as intestinal epithelium, bone marrow and gonads [4], [5]. As a rapid rate of cell division characterizes the fetal state, it is predictable that the fetus would be especially sensitive to the effects of anticancer drugs [2]. The fetus is most vulnerable to chemotherapy during the first trimester, when principal organogenesis takes place. [2], [6] If the damage to the fetus is sufficiently severe,

References (8)

  • J. Blatt et al.

    Pregnancy outcome following cancer chemotherapy

    Am J Med

    (1980)
  • L.A. DiFronzo et al.

    Breast cancer in pregnancy and lactation

    Surg Clin North Am

    (1996)
  • H.R.K. Barber

    Fetal and neonatal effects of cytotoxic agents

    Obstet Gyncol

    (1981)
  • C.L. Murray et al.

    Multimodal cancer therapy for breast cancer in the first trimester of pregnancy. A case report

    J Am Med Assoc

    (1984)
There are more references available in the full text version of this article.

Cited by (24)

  • Hypopharyngeal cancer in a pregnant woman

    2012, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
    Citation Excerpt :

    The decision to undergo therapeutic abortion must be made in early pregnancy. As a strict rule, chemotherapy must be avoided, especially during the first trimester of pregnancy [10]. When it is administered during the second and third trimesters, myelotoxicity, organ toxicity, intrauterine growth retardation, and preterm labor may occur [4,11].

  • Breast cancer and pregnancy: Challenges of chemotherapy

    2008, Critical Reviews in Oncology/Hematology
    Citation Excerpt :

    Therefore, chemotherapy should be avoided in the first trimenon. Because of the high teratogenicity at this time of pregnancy, the question of abortion was raised and further discussed in terms of an adequate, prompt therapy for the mother [47,49]. There are studies that show no difference in the prognosis of the mother if an abortion has taken place [1,50,51].

  • Antineoplastic Drugs

    2007, Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment: Second Edition
  • Antineoplastic drugs

    2007, Drugs During Pregnancy and Lactation
  • Breast cancer and pregnancy

    2021, Cancer and Pregnancy: A Practical Approach for the Gynecologist
View all citing articles on Scopus
View full text