Weekly epirubicin in the treatment of gestational breast cancer (GBC)

Background GBC is a rare disease and chemotherapy in this setting lacks a standardized approach. Patients and Methods Patients 16-30 weeks pregnant with locally advanced/metastatic disease or with high risk of recurrence after surgery were evaluated. Results Twenty patients received weekly epirubicin 35 mg/m(2). Median maternal age was 37 years (23-42). Median gestational age at chemotherapy was 19 weeks. Thirteen patients were treated after surgery while 7 had locally advanced tumours of which one had liver metastases. Mean total epirubicin dose was 420 mg/m(2) with a median number of 12 administrations (4-16). No grade 3-4 toxicities were observed. No foetal adverse events were observed except 1 premature delivery at 28 weeks. Births were induced by caesarean section in 12 patients at a median gestational age of 35 weeks. No malformations were reported except 1 newborn with polycystic kidney. At a median age of 2 years, neurological, cardiological and immunological development was normal in all children as reported by their parents. In 7/20 patients with evaluable disease, five had an objective response. At a median follow-up of 38 months, 17 patients are alive; 14 are disease free. Conclusions Weekly epirubicin appears safe and effective with low foetal toxicity and could be considered in GBC.