Pregnant and Chemotherapy: Does that work?

17. June 2010
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Is it possible to treat women with breast cancer fast with chemotherapy when they are pregnant? Can we exclude endangering the unborn? A study presented at the European Breast Cancer Conference opens up new perspectives.

In Barcelona, Sibylle Loibl, medical Professor and Gynecologist teaching at the Frankfurt University Hospital, revealed a novelty in oncology to the amazed professional audience. The central statement: Pregnant women with breast cancer can be treated with conventional chemotherapy standards – contrary to the general oncologists’ opinion – the chemical mace supposedly does not damage the unborn off-spring. Loibl’s statement indeed is path-breaking. Loibl, member of the German Breast Group (GBG), a research center for planning, organization and realization of national and international studies regarding treatment of breast cancer, refers to data of the GBG. A total of 235 patients treated between 2003 and October 2009 served as a data basis for the analysis of therapeutic side effects of chemotherapy. Those women, average age 33 years, were pregnant in the 23rd week. 91 of the patients underwent even two chemotherapy cycles before they had their babies once they had reached the term.

At first the analysis of the results appeared to be alarming, because of those 91 children nearly all had a bit less weight with an average of 2653 grams than those babies born of mothers not getting chemotherapy despite their breast cancer. Three of the new arrivals suffered from alopecia, another one was born with trisomy 18 and died after one week. One child suffered from a necrotising enterocolitis and died. In addition there were one case each of sepsis respectively neutropenia and two cases of anemia. Only when taking a closer look at the chemotherapy-free babies, the physicians realized that the health damages were statistically within the normal frame. Children born by moms abstaining from the life-expanding substances despite their breast cancer for example suffered from gastroenteritis or too high CRP-values (C-reactive proteine). “The problems cannot be ascribed to the prior chemotherapy of the mothers”, Loibl informed the professional world in Barcelona, because the rate of naturally occurring complications is at one to two percent at any rate.

Hesitant acceptance – in spite of new data

The statements come as a surprise after Loibl had referred to initial signs in 2008 during the 6. Europäischen Brustkrebskonferenz (6th European breast cancer conference) in Berlin. Back then she remained – with a few exceptions – mostly unnoticed. The German Cancer Society and the ‘Ärzte Zeitung’ (professional physician’s magazine) reported briefly. But that was it. For example the University Hospital Bonn still postulated the thesis that pregnancy and chemotherapy is a combination to be handled with caution. Thus an internet publication of the renowned university declared: “The risks of a pregnancy are unknown after the woman had received bone marrow transplantation and a high-dosed chemotherapy with or without whole-body radiation. But they could include premature birth and a low birth weight.”

The breast center at the University Women’s Hospital Duesseldorf again declared still during the Fall Symposium 2009 that chemotherapy for a pregnant woman should be done after the first Trimenon. But this is exactly what might be obsolete according to the latest statements in Barcelona. Now Loibl’s data shows that because the trimenon-period of restriction accepted only hestitantly anyways might now turn into medical history: The conference recommended to start the chemotherapy as soon as possible to the therapy plans of none-pregnant women.

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