Evolution of Angiogenic Factors in Pregnant Patients with Breast Cancer Treated with Chemotherapy

Factors angiogènics; Quimioteràpia; EmbaràsFactores angiogénicos; Quimioterapia; EmbarazoAngiogenic factors; Chemotherapy; PregnancyHigh prevalence of placental-derived complications, such as preeclampsia and intrauterine growth restriction, has been reported in women with breast cancer (BC) treated with chemotherapy during pregnancy (PBC-CHT). Aim: To ascertain whether PBC-CHT is associated with an imbalance of angiogenic factors, surrogate markers for placental insufficiency, that could explain perinatal outcomes. Methods: Prospective study between 2012 and 2016 in a single institution. Soluble fms-like tyrosine kinase (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng) in maternal blood were assessed throughout pregnancy in 12 women with BC and 215 controls. Results: Cancer patients were treated with doxorubicin-based regimes and with taxanes. Ten PBC-CHT (83%) developed obstetrical complications. At the end of the third trimester, significantly higher levels of sFlt-1; sFlt-1/PGF ratio, and sEng levels were observed in BC women as compared to controls. Moreover; there was a significant correlation between plasma levels of sFlt-1 and the number of chemotherapy cycles administered. Besides, more chemotherapy cycles correlated with lower birthweight and head circumference at birth. Conclusions: Women with BC treated during pregnancy showed an antiangiogenic state compatible with placental insufficiency. Angiogenic factors could be useful in the clinical obstetric management of these patients; although further studies will be required to guide clinical decision-making.This study was funded by the Spanish Research Project in Health funded by ISCIII, the state plan for scientific and technical research and innovation 2015–2018, and European Regional Development Fund (ERDF), ref. PI15/02252. This study was also supported in part by RETICS ‘Maternal and Child Health and Development Network’ (SAMID Network), funded by the PN I + D + i 2008–2016 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion, and the European Regional Development Fund (ERDF), ref. RD12/0026 and RD16/0022. O.S. was supported by SAMID Network (RD12/0026/0016 and RD16/0022/0015) and S.M. was supported by “Paseico de la mama”