Pregnancy After Breast Cancer in Patients With Germline BRCA Mutations-Reference-Cited by-同舟云学术

Pregnancy After Breast Cancer in Patients With Germline BRCA Mutations

Published:2020-09-10 Issue:26 Volume:38 Page:3012-3023
ISSN:0732-183X
Container-title:Journal of Clinical Oncology
language:en
Short-container-title:JCO

Author:

Lambertini Matteo¹²,Ameye Lieveke³,Hamy Anne-Sophie⁴,Zingarello Anna⁵,Poorvu Philip D.⁶,Carrasco Estela⁷,Grinshpun Albert⁸,Han Sileny⁹,Rousset-Jablonski Christine¹⁰,Ferrari Alberta¹¹,Paluch-Shimon Shani¹²,Cortesi Laura¹³,Senechal Claire¹⁴,Miolo Gianmaria¹⁵,Pogoda Katarzyna¹⁶,Pérez-Fidalgo Jose Alejandro¹⁷,De Marchis Laura¹⁸,Ponzone Riccardo¹⁹,Livraghi Luca²⁰²¹,Estevez-Diz Maria Del Pilar²²,Villarreal-Garza Cynthia²³²⁴,Dieci Maria Vittoria²⁵²⁶,Clatot Florian²⁷,Berlière Martine²⁸,Graffeo Rossella²⁹,Teixeira Luis³⁰,Córdoba Octavi³¹,Sonnenblick Amir³²,Luna Pais Helena³³,Ignatiadis Michail³⁴,Paesmans Marianne³,Partridge Ann H.⁶,Caron Olivier⁵,Saule Claire³⁵,Del Mastro Lucia¹³⁶,Peccatori Fedro A.³⁷,Azim Hatem A.²⁴

Affiliation:

1. Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy

2. Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

3. Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium

4. Department of Medical Oncology, Institut Curie, Paris, France

5. Département Médecine Oncologique, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France

6. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

7. Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain

8. Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

9. Multidisciplinary Breast Center, Department of Gynaecology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium

10. Department of Surgery, Centre Léon Bérard, Lyon, France

11. Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, and Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy

12. Breast Oncology Unit, Shaare Zedek Medical Centre, Jerusalem, Israel

13. Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy

14. Cancer Genetics Unit, Bergonie Institute, Bordeaux, France

15. Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy

16. Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

17. Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain

18. Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, “La Sapienza” University of Rome, Rome, Italy

19. Gynecological Oncology, Candiolo Cancer Institute, FPO–IRCCS, Candiolo, Turin, Italy

20. Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy

21. University of Siena, Siena, Italy

22. Department of Oncology, Instituto do Cancer do Estado de São Paulo–Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

23. Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico

24. Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Nuevo Leon, Mexico

25. Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy

26. Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy

27. Department of Medical Oncology, Centre Henri Becquerel, Rouen, France

28. Department of Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc UCL, Brussels, Belgium

29. Breast Unit of Southern Switzerland, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

30. Breast Disease Unit Saint-Louis Hospital, APHP, Université de Paris, Inserm, U976 HIPI Unit, F-75010, Paris, France

31. Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain

32. Oncology Division, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv, Israel

33. Department of Medical Oncology, Centro Hospitalar Universitário Lisboa Norte–Hospital de Santa Maria, Lisbon, Portugal

34. Department of Medical Oncology, Institut Jules Bordet and Université Libre de, Brussels, Belgium

35. Department of Genetics, Institut Curie, Paris, France

36. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

37. Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy

Abstract

PURPOSE Young women with germline BRCA mutations have unique reproductive challenges. Pregnancy after breast cancer does not increase the risk of recurrence; however, very limited data are available in patients with BRCA mutations. This study investigated the impact of pregnancy on breast cancer outcomes in patients with germline BRCA mutations. PATIENTS AND METHODS This is an international, multicenter, hospital-based, retrospective cohort study. Eligible patients were diagnosed between January 2000 and December 2012 with invasive early breast cancer at age ≤ 40 years and harbored deleterious germline BRCA mutations. Primary end points were pregnancy rate, and disease-free survival (DFS) between patients with and without a pregnancy after breast cancer. Pregnancy outcomes and overall survival (OS) were secondary end points. Survival analyses were adjusted for guarantee-time bias controlling for known prognostic factors. RESULTS Of 1,252 patients with germline BRCA mutations ( BRCA1, 811 patients; BRCA2, 430 patients; BRCA1/2, 11 patients) included, 195 had at least 1 pregnancy after breast cancer (pregnancy rate at 10 years, 19%; 95% CI, 17% to 22%). Induced abortions and miscarriages occurred in 16 (8.2%) and 20 (10.3%) patients, respectively. Among the 150 patients who gave birth (76.9%; 170 babies), pregnancy complications and congenital anomalies occurred in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up from breast cancer diagnosis was 8.3 years. No differences in DFS (adjusted hazard ratio [HR], 0.87; 95% CI, 0.61 to 1.23; P = .41) or OS (adjusted HR, 0.88; 95% CI, 0.50 to 1.56; P = .66) were observed between the pregnancy and nonpregnancy cohorts. CONCLUSION Pregnancy after breast cancer in patients with germline BRCA mutations is safe without apparent worsening of maternal prognosis and is associated with favorable fetal outcomes. These results provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

Link

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.19.02399

Reference28 articles.

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