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Trastuzumab administration during pregnancy: an update

BACKGROUND: Over than one third (28–58%) of pregnancy-associated breast cancer (PABC) cases are characterized by positive epidermal growth factor receptor 2-positive (HER2) expression. Trastuzumab anti-HER2 monoclonal antibody is still the benchmark treatment of HER2-positive breast tumors. However,...

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Autores principales: Andrikopoulou, Angeliki, Apostolidou, Kleoniki, Chatzinikolaou, Spyridoula, Bletsa, Garyfalia, Zografos, Eleni, Dimopoulos, Meletios-Athanasios, Zagouri, Flora
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074427/
https://www.ncbi.nlm.nih.gov/pubmed/33902516
http://dx.doi.org/10.1186/s12885-021-08162-3
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author Andrikopoulou, Angeliki
Apostolidou, Kleoniki
Chatzinikolaou, Spyridoula
Bletsa, Garyfalia
Zografos, Eleni
Dimopoulos, Meletios-Athanasios
Zagouri, Flora
author_facet Andrikopoulou, Angeliki
Apostolidou, Kleoniki
Chatzinikolaou, Spyridoula
Bletsa, Garyfalia
Zografos, Eleni
Dimopoulos, Meletios-Athanasios
Zagouri, Flora
author_sort Andrikopoulou, Angeliki
collection PubMed
description BACKGROUND: Over than one third (28–58%) of pregnancy-associated breast cancer (PABC) cases are characterized by positive epidermal growth factor receptor 2-positive (HER2) expression. Trastuzumab anti-HER2 monoclonal antibody is still the benchmark treatment of HER2-positive breast tumors. However, FDA has categorized Trastuzumab as a category D drug for pregnant patients with breast cancer. This systemic review aims to synthesize all currently available data of trastuzumab administration during pregnancy and provide an updated view of the effect of trastuzumab on fetal and maternal outcome. METHODS: Eligible articles were identified by a search of MEDLINE bibliographic database and ClinicalTrials.gov for the period up to 01/09/2020; The algorithm consisted of a predefined combination of the words “breast”, “cancer”, “trastuzumab” and “pregnancy”. This study was performed in accordance with the PRISMA guidelines. RESULTS: A total of 28 eligible studies were identified (30 patients, 32 fetuses). In more than half of cases, trastuzumab was administered in the metastatic setting. The mean duration of trastuzumab administration during gestation was 15.7 weeks (SD: 10.8; median: 17.5; range: 1–32). Oligohydramnios or anhydramnios was the most common (58.1%) adverse event reported in all cases. There was a statistically significant decrease in oligohydramnios/anhydramnios incidence in patients receiving trastuzumab only during the first trimester (P = 0.026, Fisher’s exact test). In 43.3% of cases a completely healthy neonate was born. 41.7% of fetuses exposed to trastuzumab during the second and/or third trimester were born completely healthy versus 75.0% of fetuses exposed exclusively in the first trimester. All mothers were alive at a median follow-up of 47.0 months (ranging between 9 and 100 months). Of note, there were three cases (10%) of cardiotoxicity and decreased ejection fraction during pregnancy. CONCLUSIONS: Overall, treatment with trastuzumab should be postponed until after delivery, otherwise pregnancy should be closely monitored.
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spelling pubmed-80744272021-04-26 Trastuzumab administration during pregnancy: an update Andrikopoulou, Angeliki Apostolidou, Kleoniki Chatzinikolaou, Spyridoula Bletsa, Garyfalia Zografos, Eleni Dimopoulos, Meletios-Athanasios Zagouri, Flora BMC Cancer Research BACKGROUND: Over than one third (28–58%) of pregnancy-associated breast cancer (PABC) cases are characterized by positive epidermal growth factor receptor 2-positive (HER2) expression. Trastuzumab anti-HER2 monoclonal antibody is still the benchmark treatment of HER2-positive breast tumors. However, FDA has categorized Trastuzumab as a category D drug for pregnant patients with breast cancer. This systemic review aims to synthesize all currently available data of trastuzumab administration during pregnancy and provide an updated view of the effect of trastuzumab on fetal and maternal outcome. METHODS: Eligible articles were identified by a search of MEDLINE bibliographic database and ClinicalTrials.gov for the period up to 01/09/2020; The algorithm consisted of a predefined combination of the words “breast”, “cancer”, “trastuzumab” and “pregnancy”. This study was performed in accordance with the PRISMA guidelines. RESULTS: A total of 28 eligible studies were identified (30 patients, 32 fetuses). In more than half of cases, trastuzumab was administered in the metastatic setting. The mean duration of trastuzumab administration during gestation was 15.7 weeks (SD: 10.8; median: 17.5; range: 1–32). Oligohydramnios or anhydramnios was the most common (58.1%) adverse event reported in all cases. There was a statistically significant decrease in oligohydramnios/anhydramnios incidence in patients receiving trastuzumab only during the first trimester (P = 0.026, Fisher’s exact test). In 43.3% of cases a completely healthy neonate was born. 41.7% of fetuses exposed to trastuzumab during the second and/or third trimester were born completely healthy versus 75.0% of fetuses exposed exclusively in the first trimester. All mothers were alive at a median follow-up of 47.0 months (ranging between 9 and 100 months). Of note, there were three cases (10%) of cardiotoxicity and decreased ejection fraction during pregnancy. CONCLUSIONS: Overall, treatment with trastuzumab should be postponed until after delivery, otherwise pregnancy should be closely monitored. BioMed Central 2021-04-26 /pmc/articles/PMC8074427/ /pubmed/33902516 http://dx.doi.org/10.1186/s12885-021-08162-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Andrikopoulou, Angeliki
Apostolidou, Kleoniki
Chatzinikolaou, Spyridoula
Bletsa, Garyfalia
Zografos, Eleni
Dimopoulos, Meletios-Athanasios
Zagouri, Flora
Trastuzumab administration during pregnancy: an update
title Trastuzumab administration during pregnancy: an update
title_full Trastuzumab administration during pregnancy: an update
title_fullStr Trastuzumab administration during pregnancy: an update
title_full_unstemmed Trastuzumab administration during pregnancy: an update
title_short Trastuzumab administration during pregnancy: an update
title_sort trastuzumab administration during pregnancy: an update
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074427/
https://www.ncbi.nlm.nih.gov/pubmed/33902516
http://dx.doi.org/10.1186/s12885-021-08162-3
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