Survey of professionals on breast cancer, fertility preservation and pregnancy in Argentina.

INTRODUCTION: Medical knowledge regarding preservation of fertility and pregnancy in patients with breast cancer (BC) is of interest. We, therefore, decided to conduct a survey on this issue among professionals involved in the treatment of BC in Argentina. MATERIALS AND METHODS: A survey was conducted and sent by email to 3,412 contacts in the Argentine Mastology Society (Sociedad Argentina de Mastología, or SAM) database, with responses from 396 physicians. The survey design was based on the Lambertini 2017 survey. To the author's knowledge, it is the first Argentine survey to address this issue. RESULTS: The frequency with which the impact of cancer treatment on the fertility of young patients was addressed by the respondent and referred to a fertility specialist was 'always' and 'almost always' in 86.8% and 78.5% of cases, respectively. CONCLUSIONS: The level of knowledge is comparable to the data presented by other surveys. Membership in a Mastology Unit was associated with more current treatment. Continued work on the training of professionals is necessary to facilitate communication, information and guidance of patients of childbearing age who are going to have cancer treatment in order to advise them on fertility preservation, as well as the possibility of pregnancy after diagnosis of BC, and to be able to provide better care to those with BC associated with pregnancy.

Impact of immunohistochemical profile changes following neoadjuvant therapy in the treatment of breast cancer.

INTRODUCTION: Currently, the indication for neoadjuvant chemotherapy is increasing in the treatment of breast cancer. Variability in the expression of biomarkers following neoadjuvant treatment has been observed, which could be accompanied by changes in the adjuvant treatment. OBJECTIVES: The primary objective was to evaluate the variability of biomarkers prior to and following neoadjuvant therapy. Secondary objectives were to determine which tumour subtype (as determined by immunohistochemical markers) most frequently achieved pathological complete response (pCR); whether the biomarker variation resulted in a change in immunophenotype and subsequently modification to the adjuvant treatment. MATERIALS AND METHODS: A retrospective observational analysis was carried out on patients with a diagnosis of breast cancer who had neoadjuvant therapy prior to surgery in the Breast Care Service of the Buenos Aires British Hospital between January 2009 and June 2020. RESULTS: One hundred and seventy-two patients were included. The pCR rate was 28.5%. The tumour immunophenotype that achieved pCR most frequently was the hormone receptor negative /HER2+ group with a value of 85.2%. The analysis was carried out on the 123 patients with residual disease. The observed variability for oestrogen receptors (ER) was 8.9%, for progesterone receptors (PR), 29.9% and for HER2, 13.8%. These changes were statistically significant. There were changes to the tumour immunophenotype in 26 cases (21.1%) with modifications to the adjuvant treatment in nine of these (34.6%; 7.3% of all tumours with residual disease). CONCLUSIONS: In this study, we observed statistically significant variability in the expression of ER, PR and HER2 prior to and following neoadjuvant treatment, which identified modifications in the tumour immunophenotype in 21.1%, and changes to the adjuvant treatment in 7.3% of all tumours with residual disease, justifying the re-assay of biomarkers in the surgical specimen.

Cáncer de mama y embarazo. Estudio retrospectivo y descriptivo en la ciudad de Rosario / Breast cancer and pregnancy in Argentina: A retrospective, descriptive study in the city of Rosario

Introducción: el cáncer de mama (CM) es el cáncer más frecuente diagnosticado durante el embarazo (PABC, del inglés Pregnancy Associatied Breast Cancer), con una incidencia de 1:3.000 embarazos. Objetivo: detallar las características clínicas e histopatológicas del PABC. Comparar estadios clínicos y detallar la sobrevida de las pacientes embarazadas y puérperas. Analizar el tratamiento durante el embarazo, los resultados obstétricos y neonatales. Material y método: estudio observacional, descriptivo y retrospectivo de PABC, en el período de enero de 2008 a julio de 2019 en los hospitales públicos y privados de la ciudad de Rosario. Resultados: del total 22 pacientes, 11 se encontraban embarazadas y 11 cursando el puerperio. La edad promedio fue de 37.3 años. La edad gestacional (EG) promedio al momento del diagnóstico fue de 16.8 semanas. En cuanto al subtipo histológico; el 72.72% (16 casos) ductal, 9.1% (2 casos) lobulillar, 4.54% (1 caso) medular, 4.54% (1 caso) cribiforme y 9.1% (2 casos) sin datos. El perfil inmuhohistoquímico mostró un 36.4% (8 casos) de triple negativos, 22.73% (5 casos) de Luminales A, 22.73% (5 casos) de Luminales B, 13.64% (3 casos) Her2 positivos y 4.5% (1 caso) sin dato. Los estudios clínicos al comparar las pacientes embarazadas y puérperas fueron similares. Estadios I y II: 7 pacientes en ambos grupos, estadios III: 2 pacientes en ambos grupos y estadios IV: 2 pacientes en ambos grupos. En el seguimiento medio de las pacientes (52.8 meses) se observó el fallecimiento de 5 de ellas (2 con diagnóstico de CM durante el puerperio y 3 durante el embarazo) y una recidiva locoregional de una paciente diagnosticada en el embarzo. Durante el embarazo, 2 pacientes realizaron cirugía conservadora y linfadenectomía seguida de quimioterapia, 1 paciente quimioterapia neoadyuvante seguida de cirugía conservadora y linfadenectomía, 3 pacientes quimioterapia y 1 paciente mastectomía y linfadenectomía. En 2 casos se difirió el tratamiento luego del parto. 2 pacientes realizaron la interrupción del embarazo en el primer trimestre. La quimioterapia fue administrada finalizando el primer trimestre. La radioterapia (RT) y la hormonoterapia se difirieron posparto, ninguna paciente realizó tratamiento anti Her2 durante la gestación. Los recién nacidos (RN) expuestos a quimioterapia intraútero (6 casos) nacieron vigorosos y sanos, ninguno presentó malformaciones. Se presentó un solo caso de bajo peso para la EG. El 44.4% (4 casos) de los embarazos fue finalizado a término, mientras que la finalización pretérmino representó el 55.6% (5 casos), con una EG medio de 34.4 semanas. En el 100% de los RN pretérmino la finalización del embarazo fue programada. Conclusiones: los subtipos más frecuentes fueron los tumores luminales. Se observó mayor frecuencia de tumores biológicamente más agresivos como el triple negativo comparado con la población general. No se encontraron diferencias al comparar los estadios clínicos al momento del diagnóstico de pacientes embarazadas vs puérperas. La quimioterapia administrada luego del primer trimestre es segura para el feto. Se debe evitar el parto prematuro, dado el pronóstico negativo de la prematuridad en el desarrollo cognitivo de los RN.

Introduction: breast cancer (BC) is the most common cancer diagnosed during pregnancy with an incidence of 1:3.000 pregnancies. Objetive: to detail the clinical and histopathological charactersitics of Pregnancy-associatied Breast Cancer (PABC). To compare clinical stages and to detail the survival of pregnant and postpartum patients. To analyze the treatment during pregnancy, and the obstetric and neonatal outcomes. Material and method: a retrospective, descriptive, and observational study of PABC was carried otu from january 2008 to july 2019 in the state and private hospitals of the city of Rosario. Results: of a total of 22 patients, 11 were pregnant and 11 were in the postpartum period. The patient´s average age was 37.3 years old. The average gestational age (GA) at the time of diagnosis was 16.8 weeks. As for the hitological subtype; 72.72% (16 cases) ductal, 9.1% (2 cases) lobular, 4.54% (1 case) cribriform and 9.1% (2 cases) without data. The immunohistochemical profile showed 36.4% triple negative, 22.73% of Luminal A, 22.73% of Luminal B, 13.64% HER2 positive, and 4.5% without data. The clinical stages when comparing pregnant and postpartum patients were similar. Stages I and II: 7 patients in both groups, stage III: 2 patients in both groups and stage IV: 2 patients in both groups. In the mean follow-up of the patients (52.8 moths), the death of 5 of them was detected (2 with a dignosis of BC during the puerperium and 3 during pregnancy) and a locoreginal recurrence of a patient diagnosed in pregnancy. During pregnancy, 2 patients underwent conservative surgery and lymphadenectomy followed by chemotherapy, 1 patient neoadjuvant chemotherapy followed by conservative surgery and lymphadenectomy, 3 patients chemotherapy and 1 patient underwent mastectomy and lymphadenectomy. In 2 cases, treatment was postponed after delivery. 2 patients performed the termination of pregnancy in the firts trimester. Chemotherapy was performed after the firts trimester. Radiotherapy (RT) and hormone therapy were postpartum deferred. None of the patients underwent anti-Her2 treatment during pregnancy. Newborns exposed to intrauterine chemotherapy (6 cases) were born vigorous and healthy, none of them presented malformations. Only one case presented low weight for gestational age. 44.4% of the pregnancies were due on term, while 55.6% were preterm births, with and average gestational age of 34.4% weeks. In 100% of preterm born infants, the end of the pregnancy was scheduled. Conclusions: the most frequent subtype were lumianl tumors. A preponderance of biologically more aggresive tumors such as triple negative was observed. The clinical stages at the time of diagnosis of pregnant and postpartum patients were similar. Chemotherapy after the first trimester is safe for the fetus. If possible, preterm bith should be avoided, giver the negative pronostic effect of prematurity on cognitive development.

Management of HER2-positive breast cancer during pregnancy: a case report.

INTRODUCTION: Breast cancer is one of the most common malignancies diagnosed during pregnancy, with an incidence of 1:3000 pregnancies. Its rising incidence is related to the trend to postpone childbearing during the last 30 years. Breast cancer during pregnancy should not be managed differently from the nonpregnant setting. Chemotherapy is reported to be safe after the first trimester, whereas trastuzumab and tamoxifen are contraindicated regardless of the trimester. CASE DESCRIPTION: A patient diagnosed with breast cancer recurrence during pregnancy was exposed to both tamoxifen and trastuzumab during the first two trimesters of pregnancy. In addition, docetaxel was administered during the second and third trimesters, without subsequent fetal malformations or obstetric complications. CONCLUSIONS: When conception occurs inadvertently during assumption of tamoxifen or anti-HER2 agents, their effects on the fetus and on the course of pregnancy are not completely understood. Further studies are needed in this setting, highlighting the importance to share clinical experiences.

Chemotherapy and anti-HER2 therapy in metastatic breast cancer in pregnancy followed by surgical treatment.

Between 5% and 10% of women have distant metastases when they receive a breast cancer (BC) diagnosis. Metastatic BC is associated with poor prognosis but advances in systemic treatments have improved survival rates in recent decades. Debates about local primary tumour management in metastatic stages continue, but multiple studies have shown that primary tumour surgery can be beneficial. BC is one of the most commonly diagnosed neoplasias during pregnancy. Treatment of pregnant BC patients should follow the standard treatment of young, non-pregnant patients as closely as possible. We present the case of a young, pregnant patient with metastatic BC with a complete clinical response to chemotherapy followed by surgical treatment.