Background Cancer chemotherapy during pregnancy is a challenging problem. There are multiple case reports and reviews indicating that the risk of fetal malformation is rare with cytotoxic chemotherapy if administered after 14 weeks of gestation. There is, however, limited information on the risks of taxanes during pregnancy (3 case reports on paclitaxel and 1 on docetaxel). We describe two additional patients who received docetaxel during pregnancy, with one child having a minor, but probably unrelated, birth defect.
Case Reports Case #1: A 29-year-old female was diagnosed with breast cancer stage IIIA at 12 weeks of gestation. Biopsy revealed grade IIIA infiltrating ductal carcinoma. Estrogen and progesterone receptors and HER2neu were all positive. She was started on neoadjuvant chemotherapy at 14 weeks of gestation with doxorubicin and cyclophosphamide (4 cycles). The patient had a fetal ultrasound at 17 weeks of gestation, which revealed hydrocephalus. She had a mastectomy and node dissection at 24 weeks. She received 4 cycles of taxotere (75 mg/m2) every 2 weeks between weeks 26 and 32. She delivered at 34 weeks with the infant having mild hydrocephalus, which regressed over several months. The child's development has been normal at 24 months. Case #2: A 38-year-old female was diagnosed with breast cancer stage IIIA at 10 weeks of gestation. Biopsy demonstrated poorly differentiated infiltrating ductal carcinoma with estrogen and progesterone receptors positive and HER2neu negative. She began neoadjuvant chemotherapy at 14 weeks of gestation with doxorubicin and docetaxel (75 mg/m2) every 3 weeks for 6 cycles. She developed preeclampsia and underwent cesarean delivery of a healthy child at 35 weeks. Child development has been normal at 6 months.
Conclusion Adjuvant therapy of breast cancer with taxanes reduces the risk of cancer recurrence. Pregnant cancer patients can be treated with chemotherapy including taxanes during the second and third trimesters without significant risks to the fetus. Taxanes should not be excluded, if indicated, in the pregnant cancer patient.