Favorable pregnancy outcome following Trastuzumab (Herceptin®) use during pregnancy—Case report and updated literature review

doi:10.1016/j.reprotox.2007.02.003

Reproductive Toxicology

Volume 23, Issue 4, June 2007, Pages 611-613

https://doi.org/10.1016/j.reprotox.2007.02.003 Get rights and content

Abstract

Background

Trastuzumab (Herceptin^®) is a monoclonal antibody used for the treatment of breast cancer. Experience with use of this agent during pregnancy, and its possible effects on the fetus, is limited.

Case

We present a case of a patient with breast cancer who was treated with trastuzumab during the first 24 weeks of pregnancy. This treatment was associated with reversible maternal heart failure, which resolved slowly after the drug was discontinued, but with no adverse fetal effects and a normal infant examination at the age of 2 months. Updated literature review is discussed.

Introduction

Trastuzumab (Herceptin^®) is a monoclonal antibody directed against the human epidermal growth factor receptor 2 (HER-2) protein, a member of the epidermal growth factor receptor family, which when over-expressed, causes increased cell growth and proliferation leading to a more aggressive breast cancer. Trastuzumab is an effective drug in the treatment of HER2-positive breast cancer [1].

Although the majority of breast cancers occur in the menopausal and peri-menopausal age group, about 5% of breast cancers occur in pre-menopausal women less than 40 years of age [2]. Breast cancer occurs in about 1 in 3000 pregnancies every year [3], [4] and is the most commonly diagnosed cancers during gestation [5]. Incidence of breast cancer in pregnancy is expected to increase as more women delay conception [5]. The potential for exposure of fetuses to trastuzumab increases in this younger, fertile age group, as more women are treated with this drug.

We report a case of trastuzumab exposure during gestation, with an apparently uneventful fetal outcome, as well as an updated review of the published literature.

Section snippets

Case

A 32-year-old woman, G2P0, was referred for evaluation at 5 weeks gestational age. She had been married for 3 years at the time of consultation and had a family history of cancer on her father's side; her father had bladder cancer at the age of 64 years; her first cousin had a brain tumor at 33 years, and her paternal aunt had breast cancer at 58 years. No other familial health problems were identified.

Four years prior to her current presentation, while in her first pregnancy, she was diagnosed

Discussion

The management of breast cancer during pregnancy is a complex clinical issue due to the potential fetal risk posed by cancer treatment in juxtaposition with the potential risks of delaying treatment for the mother.

Treatment with trastuzumab has been shown to improve outcomes in the treatment of HER2-positive breast cancer [1].

Acknowledgments

Supported in part by the research Leadership for Better Pharmacotherapy during pregnancy and Lactation (Hospital for Sick Children) and the Ivey chair in molecular toxicology, Department of Medicine, University of western Ontario. AS was supported by a grant from the Hospital for Sick Children's research training centre. The Motherisk-NVP line is supported in part by Duchesnay Inc., Laval, Canada.

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Short communicationFavorable pregnancy outcome following Trastuzumab (Herceptin®) use during pregnancy—Case report and updated literature review

Abstract

Background

Case

Introduction

Section snippets

Case

Discussion

Acknowledgments

Breast

Early Hum Dev

Clin Breast Cancer

Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer

N Engl J Med

Pregnancy in association with a newly diagnosed cancer: a population-based epidemiologic assessment

Int J Cancer

Cancer in pregnancy: a review of the literature. Part I

Obstet Gynecol Surv

Short communication
Favorable pregnancy outcome following Trastuzumab (Herceptin^®) use during pregnancy—Case report and updated literature review