Contraception is as important as fertility preservation in young women with cancer

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Genetic and microscopic assessment of the human chemotherapy-exposed placenta reveals possible pathways contributive to fetal growth restriction

Fetal growth restriction (FGR) carries an increased risk of perinatal mortality and morbidity. A major cause of FGR is placental insufficiency. After in utero chemotherapy-exposure, an increased incidence of FGR has been reported. In a prospective cohort study we aimed to explore which pathways may contribute to chemotherapy-associated FGR.status: publishe

Genetic and microscopic assessment of the human chemotherapy-exposed placenta reveals possible pathways contributive to fetal growth restriction (vol 64, pg 61, 2018)

© 2018 Elsevier Ltd The authors regret that the funding part states an incorrect grant number of the CRADLE consolidator grant, granted by the European Research Council. The official and correct grant number is: 647047. The authors would like to apologise for any inconvenience caused.status: publishe

Prognosis of 368 women with primary breast cancer diagnosed during pregnancy: results from an international collaborative trial

Objective: We aimed to add to the limited outcome data on breast cancer during pregnancy (BCP), and compared disease-free survival (DFS), and overall survival (OS) between patients with BCP and breast cancer not diagnosed during pregnancy, adjusted for known prognostic factors. Methods: We analyzed a pro- and retrospectively compiled multi-centric registry of BCP patients (www.cancerinpregnancy.org and GBG/BIG 0203). Outcome was compared to a control group of patients who did not have associated pregnancies. The main analysis is a Cox proportional hazards regression of disease free survival (DFS) and overall survival (OS) on exposure (pregnant or not). The analysis was weighted by propensity score matching to correct for any bias that may have been associated with differences in baseline characteristics, with the following set of covariates: age, stage, grade, hormone receptor status, HER2 status, histology, type of chemotherapy and trastuzumab. Sensitivity analysis was also performed on age only, and also on chemotherapy only. Results: From April 2003-December 2011, 447 women with BCP were registered, 368 women with BCP were eligible for this analysis. The control group consisited of 2739 women (ratio 1:7.44)

Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy

BACKGROUND Data on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking. METHODS In this multicenter case-control study, we compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis. We used a health questionnaire and medical files to collect data regarding neonatal and general health. All children were prospectively assessed (by means of a neurologic examination and the Bayley Scales of Infant Development) at 18 months, 36 months, or both. A cardiac assessment was performed at 36 months. RESULTS A total of 129 children (median age, 22 months; range, 12 to 42) were included in the group whose mother had cancer (prenatal-exposure group) with a matching number in the control group. During pregnancy, 96 children (74.4%) were exposed to chemotherapy (alone or in combination with other treatments), 11 (8.5%) to radiotherapy (alone or in combination), 13 (10.1%) to surgery alone, 2 (1.6%) to other drug treatments, and 14 (10.9%) to no treatment. Birth weight was below the 10th percentile in 28 of 127 children (22.0%) in the prenatal-exposure group and in 19 of 125 children (15.2%) in the control group (P = 0.16). There was no significant between-group difference in cognitive development on the basis of the Bayley score (P = 0.08) or in subgroup analyses. The gestational age at birth was correlated with the cognitive outcome in the two study groups. Cardiologic evaluation among 47 children at 36 months of age showed normal cardiac findings. CONCLUSIONS Prenatal exposure to maternal cancer with or without treatment did not impair the cognitive, cardiac, or general development of children in early childhood. Prematurity was correlated with a worse cognitive outcome, but this effect was independent of cancer treatment

Treatment of breast cancer during pregnancy: an observational study

Background Little is known about the treatment of breast cancer during pregnancy. We aimed to determine whether treatment for breast cancer during pregnancy is safe for both mother and child. Methods We recruited patients from seven European countries with a primary diagnosis of breast cancer during pregnancy; data were collected retrospectively if the patient was diagnosed before April, 2003 (when the registry began), or prospectively thereafter, irrespective of the outcome of pregnancy and the type and timing of treatment. The primary endpoint was fetal health for up to 4 weeks after delivery. The registry is ongoing. The study is registered with ClinicalTrials.gov, number NCT00196 Findings From April, 2003, to December, 2011, 447 patients were registered, 413 of whom had early breast cancer. Median age was 33 years (range 22-51). At the time of diagnosis, median gestational age was 24 weeks (range 5-40). 197 (48%) of 413 women received chemotherapy during pregnancy with a median of four cycles (range one to eight). 178 received an anthracycline, 15 received cyclophosphamide, methotrexate, and fluorouracil, and 14 received a taxane. Birthweight was affected by chemotherapy Interpretation Although our data show that infants exposed to chemotherapy in utero had a lower birthweight at gestational age than did those who were unexposed, and had more complications, these differences were not clinically significant and, since none of the infants was exposed to chemotherapy in the first trimester, were most likely related to premature delivery. Delay of cancer treatment did not significantly affect disease-free survival for mothers with early breast cancer. Because prete