Outcome of breast cancer patients treated with chemotherapy during pregnancy compared with non-pregnant controls

Frédéric Amant*, Valentina Nekljudova, Charlotte Maggen, Fenja Seither, Patrick Neven, Elyce H. Cardonick, Sabine Schmatloch, Kristel Van Calsteren, Tatjana Cordes, Jorine de Haan, Christianne A.R. Lok, Felix Flock, Ingrid A. Boere, Mina M. Gziri, Christine Solbach, Hanne Lefrère, Andreas Schneeweiss, Isabell Witzel, Sabine Seiler, Sibylle Loibl

*Corresponding author for this work

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Abstract

Background: A diagnosis of breast cancer during pregnancy (PrBC) does not impact prognosis if standard treatment is offered. However, caution is warranted as gestational changes in pharmacokinetics may lead to reduced chemotherapy concentration. Methods: Survival of PrBC patients treated with chemotherapy during pregnancy was compared to non-pregnant breast cancer patients treated with chemotherapy, diagnosed after 2000, excluding patients older than 45 years or with a postpartum diagnosis. The data was registered in two multicenter registries (the International Network of Cancer, Infertility and Pregnancy and the German Breast Group). Cox proportional hazards regression was used to compare disease-free (DFS) and overall survival (OS) between both groups, adjusting for age, stage, grade, hormone receptor status, human epidermal growth factor 2 status and histology, weighted by propensity scoring to account for the differences in baseline characteristics between pregnant patients and controls. Results: In total, 662 pregnant and 2081 non-pregnant patients were selected. Pregnant patients were more likely to have stage II breast cancer (60.1% vs 56.1%, p = 0.035), grade 3 tumors (74.0% vs 62.2%, p < 0.001), hormone receptor-negative tumors (48.4% vs 34.0%, p < 0.001) or triple-negative breast cancer (38.9% vs 26.9%, p < 0.001). Median follow-up was 66 months. In multivariable analysis, DFS and OS were comparable for pregnant and non-pregnant patients (DFS: HR 1.02, 95% CI 0.82–1.27, p = 0.83; OS: HR 1.08, 95% CI 0.81–1.45, p = 0.59). Conclusion: Outcome of women with breast cancer treated with chemotherapy during pregnancy is comparable to young non-pregnant women. These results support chemotherapy for PrBC when indicated.

Original languageEnglish
Pages (from-to)54-63
Number of pages10
JournalEuropean Journal of Cancer
Volume170
DOIs
Publication statusPublished - 1 Jul 2022

Bibliographical note

Funding Information:
The authors declare the following financial interests/personal relationships that may be considered as potential competing interests: SL reports grants from AbbVie , Celgene , AstraZeneca , Amgen , Novartis , Pfizer , Daiichi-Sankyo , Immunomedics, and Roche; advisory board honoraria paid to the institution from AbbVie, Celgene, AstraZeneca, Amgen, Novartis , Pfizer , Lilly , Bristol Myers Squibb , Puma, Pierre Fabre , Merck Sharp and Dohme , and EirGenix; speaker honoraria paid to their institution from AbbVie , Celgene , AstraZeneca , Amgen , Novartis , Pfizer , and PriME/Medscape; personal fees from Chugai and Daiichi-Sankyo; honoraria for advisory board participation and speaking fees paid to the institution from Daiichi-Sankyo , Roche , and SeaGen; and has a patent (EP18209682.7). AS reports grants from Celgene , Roche , AbbVie; personal fees from Celgene , Roche , Pfizer , AstraZeneca , Novartis , MSD , Tesaro, Lilly . IB reports grants from GSK and support from AstraZeneca . SS reports support from Novartis , personal fees from Roche , Mundipharma, Amgen , Abbvie . All other authors declare no competing interests.

Funding Information:
Funding for this PrBC project was provided by GBG. INCIP has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 647047. We are grateful to the Research Foundation-Flanders (FWO., grant no G070514N), Kom op tegen kanker, Stichting tegen kanker and ESGO (European Society of Gynecological Oncology) for the support. FA is senior clinical investigator of the F.W.O. The funding source had no role in study design.The authors declare the following financial interests/personal relationships that may be considered as potential competing interests: SL reports grants from AbbVie, Celgene, AstraZeneca, Amgen, Novartis, Pfizer, Daiichi-Sankyo, Immunomedics, and Roche; advisory board honoraria paid to the institution from AbbVie, Celgene, AstraZeneca, Amgen, Novartis, Pfizer, Lilly, Bristol Myers Squibb, Puma, Pierre Fabre, Merck Sharp and Dohme, and EirGenix; speaker honoraria paid to their institution from AbbVie, Celgene, AstraZeneca, Amgen, Novartis, Pfizer, and PriME/Medscape; personal fees from Chugai and Daiichi-Sankyo; honoraria for advisory board participation and speaking fees paid to the institution from Daiichi-Sankyo, Roche, and SeaGen; and has a patent (EP18209682.7). AS reports grants from Celgene, Roche, AbbVie; personal fees from Celgene, Roche, Pfizer, AstraZeneca, Novartis, MSD, Tesaro, Lilly. IB reports grants from GSK and support from AstraZeneca. SS reports support from Novartis, personal fees from Roche, Mundipharma, Amgen, Abbvie. All other authors declare no competing interests.

Funding Information:
Funding for this PrBC project was provided by GBG. INCIP has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 647047 . We are grateful to the Research Foundation-Flanders (FWO., grant no G070514N ), Kom op tegen kanker, Stichting tegen kanker and ESGO (European Society of Gynecological Oncology) for the support. FA is senior clinical investigator of the F.W.O. The funding source had no role in study design.

Publisher Copyright:
© 2022 Elsevier Ltd

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