treatment of breast cancer during pregnancy regimen selection pregnancy monitoring and more

Abstract Breast cancer is uncommonly diagnosed during pregnancy but when encountered, it poses several clinical conflicts. Managing patients with gestational breast cancer should not be associated with considerable risk of morbidity provided the choice of the right drug in the right time for the right patient. Due to its relative rarity, we lack a standardized approach to manage these patients. Previous reports have suggested that women can be offered treatment strategies similar to those offered in the "non-pregnant" setup. Nevertheless, generalizing treatment decisions is too hard and treatment of these cases should be tailored according to the clinical situation. In order to ensure proper counseling of these patients, there are several key points that need to be addressed. These include timing of chemotherapy administration, the scheduling of agents, and pregnancy monitoring. In this review, we provide some guidance on how to select the chemotherapy regimen and address the feasibility and safety of administering trastuzumab during pregnancy. We also discuss some practical points on monitoring these patients during the course of pregnancy

Frequency of Pregnancy‐Associated Cancer: A Systematic Review of Population‐Based Studies

Despite numerous available resources of evidence, the results about the frequency of pregnancy\u2010associated cancer (PAC) still show poor comparability due to dissimilarities in the study design and methodology, inclusion criteria, incoherent duration of follow\u2010up and a heterogeneous reference population. We conducted a systematic review of population\u2010based studies on PAC published up to December 2019, to provide updated research on this topic, highlighting strengths and limitations. Of the 24 papers included, 11 considered all types of tumors and 13 dealt with specific types of cancer. Differences in the procedures for estimating the frequency of PAC emerged even among population studies. However, we found consistent results for overall frequency of PAC\u2014 around 1/1000 pregnancies. Our review suggests that about 25% of PAC cases are diagnosed during pregnancy, confirming the hypothesis of an excess of diagnosis in the postpregnancy period. Sparse and inconsistent results were found regarding a potential increase in the frequency of PAC over calendar years. Alignments in the strategy to identify PAC are needed to overcome methodological weaknesses

adolescents and young adults with cancer care in asia the joint esmo siope siop asia survey

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Hematologic malignancies in pregnancy : Management guidelines from an international consensus meeting

Purpose: The incidence of hematologic malignancies during pregnancy is 0.02%. However, this figure is increasing, as women delay conception until a later age. Systemic symptoms attributed to the development of a hematologic cancermay overlapwith physiologic changes of pregnancy. A favorable prognosis is contingent upon early diagnosis and treatment. Therefore, a high index of suspicion is required by health care providers. Although timely, accurate diagnosis followed by appropriate staging is essential and should not be delayed due to pregnancy, management guidelines are lacking due to insufficient evidence-based research. Consequently, treatment is delayed, posing significant risks to maternal and fetal health, and potential pregnancy termination. This report provides guidelines for clinical management of hematologic cancers during the perinatal period, which were developed by a multidisciplinary team including an experienced hematologist/oncologist, a high-risk obstetrics specialist, a neonatologist, and experienced nurses, social workers, and psychologists. Methods: These guidelines were developed by experts in the field during the first International Consensus Meeting of PrenatalHematologicMalignancies, which took place in Leuven, Belgium, onMay 23, 2014. Results and Conclusion: This consensus summary equips health care professionals with novel diagnostic and treatment methodologies that aimfor optimal treatment of themother, while protecting fetal and pediatric health

Who are the women who enrolled in the POSITIVE trial: a global study to support young hormone receptor positive breast cancer survivors desiring pregnancy

Background: Premenopausal women with early hormone-receptor positive (HR+) breast cancer receive 5-10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may wane. The POSITIVE study investigates the impact of temporary ET interruption to allow pregnancy. Methods: POSITIVE enrolled women with stage I-III HR + early breast cancer, <42 years, who had received 18-30 months of adjuvant ET and wished to interrupt ET for pregnancy. Treatment interruption for up to 2 years was permitted to allow pregnancy, delivery and breastfeeding, followed by ET resumption to complete the planned duration. Findings: From 12/2014 to 12/2019, 518 women were enrolled at 116 institutions/20 countries/4 continents. At enrolment, the median age was 37 years and 74.9 % were nulliparous. Fertility preservation was used by 51.5 % of women. 93.2 % of patients had stage I/II disease, 66.0 % were node-negative, 54.7 % had breast conserving surgery, 61.9 % had received neo/adjuvant chemotherapy. Tamoxifen alone was the most prescribed ET (41.8 %), followed by tamoxifen + ovarian function suppression (OFS) (35.4 %). A greater proportion of North American women were <35 years at enrolment (42.7 %), had mastectomy (59.0 %) and received tamoxifen alone (59.8 %). More Asian women were nulliparous (81.0 %), had node negative disease (76.2%) and received tamoxifen + OFS (56.0 %). More European women had received chemotherapy (69.3 %). Interpretation: The characteristics of participants in the POSITIVE study provide insights to which patients and doctors considered it acceptable to interrupt ET to pursue pregnancy. Similarities and variations from a regional, sociodemographic, disease and treatment standpoint suggest specific sociocultural attitudes across the world. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

ESMO / ASCO Recommendations for a Global Curriculum in Medical Oncology Edition 2016

The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) are publishing a new edition of the ESMO/ASCO Global Curriculum (GC) thanks to contribution of 64 ESMO-appointed and 32 ASCO-appointed authors. First published in 2004 and updated in 2010, the GC edition 2016 answers to the need for updated recommendations for the training of physicians in medical oncology by defining the standard to be fulfilled to qualify as medical oncologists. At times of internationalisation of healthcare and increased mobility of patients and physicians, the GC aims to provide state-of-the-art cancer care to all patients wherever they live. Recent progress in the field of cancer research has indeed resulted in diagnostic and therapeutic innovations such as targeted therapies as a standard therapeutic approach or personalised cancer medicine apart from the revival of immunotherapy, requiring specialised training for medical oncology trainees. Thus, several new chapters on technical contents such as molecular pathology, translational research or molecular imaging and on conceptual attitudes towards human principles like genetic counselling or survivorship have been integrated in the GC. The GC edition 2016 consists of 12 sections with 17 subsections, 44 chapters and 35 subchapters, respectively. Besides renewal in its contents, the GC underwent a principal formal change taking into consideration modern didactic principles. It is presented in a template-based format that subcategorises the detailed outcome requirements into learning objectives, awareness, knowledge and skills. Consecutive steps will be those of harmonising and implementing teaching and assessment strategies

Setting up an ethical oncofertility practice in developing countries

Fertility preservation for cancer patients is a relatively new field in medicine which requires interdisciplinary approach. Improving therapies and rising survival rates require to consider patient\u2019s quality of life after cancer is cured which is relevant personal issue regardless of the individual income and the level of development of the country of origin. Fertility preservation offers possible solution but also raises ethical questions. We provide a summary of ethical principles embodied in professional guidelines together with options and restrictions to access fertility preservation in developing countries. We also make a suggestion that oncofertility counselling could be a pillar to address fertility preservation issues in cancer patients. Our proposed decisional support model is patient centred and focuses on patient values, personal philosophy and view of life emphasizing sensitivity to individual patient\u2019s needs and wishes. Some fertility preservation concerns in oncology might be addressed mirroring already available expertise while some others will call for innovative and region specific solutions. Therefore, in addition to our proposal we also provide a list of organisations working in oncofertility field

Risk factors: after gestational chemotherapy, the kids are all right

When a pregnant woman is diagnosed with cancer, clinical management is complicated by concerns about the possible detrimental effects of cancer treatments on pregnancy outcome and the health of the baby. Evidence about the outcomes of children after maternal chemotherapy for cancer during pregnancy is growing and we can say 'the kids are all right'