Study provides ‘increased confidence’ about using taxanes for breast cancer in pregnancy
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Key takeaways:
- Pregnant women who received taxane-based chemotherapy achieved an overall live birth rate of 98%.
- Researchers observed a trend toward lower rates of preterm births.
Taxane-based chemotherapy appeared safe and effective during pregnancy for young women with breast cancer, according to study results.
The findings — presented at San Antonio Breast Cancer Symposium — showed a prevalence of maternal and neonatal adverse events comparable to that observed with other chemotherapy agents commonly used during pregnancy.
“There are limited data and conflicting recommendations regarding the safety of taxanes for the treatment of breast cancer during pregnancy,” Ana Ferrigno Guajardo, MD, resident in the department of internal medicine at Yale University School of Medicine, told Healio. “The management of breast cancer during pregnancy is a challenging clinical scenario, as the expected benefits of systemic treatment must be carefully balanced against the potential harms to the developing fetus.”
Although anthracycline-based chemotherapy regimens are considered standard treatment for breast cancer during pregnancy, the addition of taxanes may improve survival outcomes, she continued.
“However, there is tendency to delay taxane treatment until after delivery due to concerns about potential harm to the developing fetus,” Ferrigno Guajardo said. “Our study aimed to address these concerns and provide a more comprehensive understanding of the safety profile of taxanes during pregnancy.”
The international cohort study included 103 women (median age, 34 years) with breast cancer who received taxane-based chemotherapy during pregnancy. The majority (90.1%) were exposed to anthracyclines.
Median gestational age was 16 weeks at initiation of any chemotherapy agent and 28 weeks at initiation of taxane-based chemotherapy. Paclitaxel was the most frequently prescribed taxane (97.1%), with most women receiving an 80 mg/m² weekly infusion.
All cases were singleton pregnancies — except for one twin pregnancy — for an overall live birth rate of 98%. Researchers reported a median gestational age at delivery of 37 weeks, with a preterm live birth rate of 43.3% and median birth weight of 2,700 grams.
The most common grade 3 to grade 4 maternal adverse events included hypersensitivity reaction (2.9%), neutropenia (2.9%), thrombocytopenia (1%) and nausea/vomiting (1%). Neonatal complications included small for gestational age (24.3%), hyperbilirubinemia (12.5%), respiratory distress syndrome (5.7%), hypoglycemia (5.7%) and need for respiratory support (4.3%).
“There is a trend toward lower rates of preterm births observed in recent years, suggesting improved management strategies,” Ferrigno Guajardo said. “Additionally, the majority of children exposed to taxanes in utero did not experience any long-term health problems.”
Most neonates (96.6%) received a 5-minute Apgar score 7, and 15.9% were admitted to the neonatal intensive care unit.
At median follow-up of 42 months, data on adverse events were available for 28 neonates. Investigators reported one case each of cardiac abnormality, speech disorder, renal disfunction and femoral anteversion.
“We hope our findings inform clinical practice guidelines that provide evidence-based recommendations for health care providers managing this complex patient population,” Ferrigno Guajardo said. “Clinicians can now have increased confidence using taxanes as part of the treatment plan for breast cancer during pregnancy, potentially leading to improved patient outcomes. Furthermore, women diagnosed with breast cancer during pregnancy can now have more information regarding treatment outcomes that can facilitate informed decision-making about treatment options.”
Researchers recommend further research to examine the long-term effects of taxane exposure on children born to mothers treated during pregnancy; evaluate the safety and efficacy of taxane regimens other than weekly paclitaxel; and explore factors contributing to preterm delivery among pregnant women with breast cancer. They also recommended larger prospective studies be conducted to further strengthen the evidence base for use of taxanes during pregnancy.
“Taxanes, especially weekly paclitaxel, appear to be a safe and effective treatment option for breast cancer during pregnancy,” Ferrigno Guajardo said. “This research provides valuable evidence for pregnant women and their health care providers, offering reassurance and facilitating informed decisions about management strategies. While further research is needed, these findings represent a step forward in improving the care and outcomes for women diagnosed with breast cancer during pregnancy.”
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Ferrigno Guajardo A, et al. Abstract PS13-03. Presented at: San Antonio Breast Cancer Symposium; Dec. 5-9, 2023; San Antonio.
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