Moffitt Oncology Report 10/26: Gestational Breast Cancer and Hypercalcemia of Malignancy

Had an interesting discussion about breast cancer during pregnancy. Not a condition we see very often. See below from learning from our oncologist and more!

Take-home point: the pregnancy risk of a medication is always about a discussion of the risk vs benefit and also consideration of which trimester. In general, the first trimester is the most vulnerable since this is when the majority of organogenesis occurs.

Additional learning

Gestational breast cancer

  • What is gestational breast cancer? Breast cancer diagnosed during pregnancy or the first postpartum year
  • How is it treated? In general, these are treated the same way as nonpregnant patients with some adjustments to protect the baby. Locoregional treatment is the same with surgery, except XRT is usually withheld until after delivery. Studies show it seems safe to use traditional systemic chemo to treat gestational breast cancer AFTER the first trimester. Majority of pregnancies end up with no chemo-related complications. Most use anthracycline-based chemo (e.g. doxorubicin + cyclophosphamide).
    • Cannot use other Ab therapies like trastuzumab (Herceptin), SERMs or aromatase inhibitors
  • What about prognosis? Outcomes for women with gestational breast cancer are equivalent to breast cancer in nonpregnant women

Hypercalcemia of malignancy: Mechanisms of hypercalcemia

  • PTHrP: squamous cells (lung, head and neck), renal, bladder, breast or ovarian
  • Osteolytic mets: breast, multiple myeloma
  • Increased production of 1,25 OH-Vit D: Lymphoma
  • Ectopic PTH secretion from tumor: ovarian, lung (small cell, ,squamous), thyroid
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