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Article: Adjuvant breast cancer chemotherapy during late-trimester pregnancy: Not quite a standard of care

TitleAdjuvant breast cancer chemotherapy during late-trimester pregnancy: Not quite a standard of care
Authors
Issue Date2007
PublisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmccancer/
Citation
BMC Cancer, 2007, v. 7, article no. 92 How to Cite?
AbstractBackground: Diagnosis of breast cancer during pregnancy was formerly considered an indication for abortion. The pendulum has since swung to the other extreme, with most reviews now rejecting termination while endorsing immediate anthracycline-based therapy for any pregnant patient beyond the first trimester. To assess the evidence for this radical change in thinking, a review of relevant studies in the fields of breast cancer chemotherapy, pregnancy, and drug safety was conducted. Discussion: Accumulating evidence for the short-term safety of anthracycline-based chemotherapy during late-trimester pregnancy represents a clear advance over the traditional norm of therapeutic abortion. Nonetheless, the emerging orthodoxy favoring routine chemotherapy during gestation should continue to be questioned on several grounds: (1) the assumed difference in maternal survival accruing from chemotherapy administered earlier - i.e., during pregnancy, rather than after delivery - has not been quantified; (2) the added survival benefit of adjuvant cytotoxic therapy prescribed within the hormone-rich milieu of pregnancy remains presumptive, particularly for ER-positive disease; (3) the maternal survival benefit associated with modified adjuvant regimens (e.g., weekly schedules, omission of taxanes, etc.) has not been proven equivalent to standard (e.g., post-delivery) regimens; and (4) the long-term transplacental and transgenerational hazards of late-trimester chemotherapy are unknown. Summary: Although an incrementally increased risk of cancer-specific mortality is impossible to exclude, mothers who place a high priority on the lifelong well-being of their progeny may be informed that deferring optimal chemotherapy until after delivery is still an option to consider, especially in ER-positive, node-negative and/or last-trimester disease. © 2007 Epstein; licensee BioMed Central Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/76600
ISSN
2015 Impact Factor: 3.265
2015 SCImago Journal Rankings: 1.627
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorEpstein, RJen_HK
dc.date.accessioned2010-09-06T07:22:57Z-
dc.date.available2010-09-06T07:22:57Z-
dc.date.issued2007en_HK
dc.identifier.citationBMC Cancer, 2007, v. 7, article no. 92en_HK
dc.identifier.issn1471-2407en_HK
dc.identifier.urihttp://hdl.handle.net/10722/76600-
dc.description.abstractBackground: Diagnosis of breast cancer during pregnancy was formerly considered an indication for abortion. The pendulum has since swung to the other extreme, with most reviews now rejecting termination while endorsing immediate anthracycline-based therapy for any pregnant patient beyond the first trimester. To assess the evidence for this radical change in thinking, a review of relevant studies in the fields of breast cancer chemotherapy, pregnancy, and drug safety was conducted. Discussion: Accumulating evidence for the short-term safety of anthracycline-based chemotherapy during late-trimester pregnancy represents a clear advance over the traditional norm of therapeutic abortion. Nonetheless, the emerging orthodoxy favoring routine chemotherapy during gestation should continue to be questioned on several grounds: (1) the assumed difference in maternal survival accruing from chemotherapy administered earlier - i.e., during pregnancy, rather than after delivery - has not been quantified; (2) the added survival benefit of adjuvant cytotoxic therapy prescribed within the hormone-rich milieu of pregnancy remains presumptive, particularly for ER-positive disease; (3) the maternal survival benefit associated with modified adjuvant regimens (e.g., weekly schedules, omission of taxanes, etc.) has not been proven equivalent to standard (e.g., post-delivery) regimens; and (4) the long-term transplacental and transgenerational hazards of late-trimester chemotherapy are unknown. Summary: Although an incrementally increased risk of cancer-specific mortality is impossible to exclude, mothers who place a high priority on the lifelong well-being of their progeny may be informed that deferring optimal chemotherapy until after delivery is still an option to consider, especially in ER-positive, node-negative and/or last-trimester disease. © 2007 Epstein; licensee BioMed Central Ltd.en_HK
dc.languageengen_HK
dc.publisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmccancer/en_HK
dc.relation.ispartofBMC Canceren_HK
dc.rightsBMC Cancer. Copyright © BioMed Central Ltd.en_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.titleAdjuvant breast cancer chemotherapy during late-trimester pregnancy: Not quite a standard of careen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1471-2407&volume=7&spage=92&epage=7&date=2007&atitle=Adjuvant+breast+cancer+chemotherapy+during+late-trimester+pregnancy+–+not+quite+a+standard+of+careen_HK
dc.identifier.emailEpstein, RJ: repstein@hku.hken_HK
dc.identifier.authorityEpstein, RJ=rp00501en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1186/1471-2407-7-92en_HK
dc.identifier.pmid17537241-
dc.identifier.pmcidPMC1894980-
dc.identifier.scopuseid_2-s2.0-34347230914en_HK
dc.identifier.hkuros131218en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-34347230914&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume7en_HK
dc.identifier.spagearticle no. 92-
dc.identifier.epagearticle no. 92-
dc.identifier.isiWOS:000247545700001-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridEpstein, RJ=34975074500en_HK
dc.identifier.citeulike1345106-

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