SESSION TITLE: Interstitial Lung Disease Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 27, 2013 at 07:30 AM - 08:30 AM
INTRODUCTION: Breast carcinoma is the second most common malignancy during pregnancy.The disease presents clinicians with a challenging ethical and treatment dilemma to balance between a life saving therapy for mother and potential life threatening therapy for fetus.There is limited literature documenting the effects of Cyclophosphamide and Adriamycin on developing fetal lung.
CASE PRESENTATION: Male SGA infant was born to 28 year old woman at 33 weeks gestation via C-section. Mother was diagnosed with breast cancer at 9 weeks of gestation and was treated with Adriamycin and Cyclophosphamide at 24 weeks of gestation. At birth the baby had respiratory distress and was managed with CPAP and oxygen. His respiratory course was complicated by inability to wean from oxygen. Chest X-ray done at 2 months of age, showed findings suggestive of chronic lung disease of unknown etiology. Chest CT revealed bilateral diffuse interstitial and alveolar opacities. Lung biopsy was declined by parents.Patient clinical symptoms improved gradually and he was successfully weaned off oxygen by one year of age.
DISCUSSION: Antenatal exposure to chemotherapeutic agents given to mother during pregnancy raises questions about the effect on fetal development and long term outcomes.Cyclophosphamide and Adriamycin are pregnancy category D agents, however, potential benefits may warrant treatment with these agents during pregnancy.Cyclophosphamide exposure in second and third trimester has not been shown to produce congenital malformations but has been associated with growth restriction, microcephaly and neonatal pancytopenia.
CONCLUSIONS: The risk of fetal anomalies in neonates exposed to chemotherapy in utero is highest during the first trimester, however the risk is not eliminated in the second and third trimester. There are no reported cases of second and third trimester effect of chemotherapy on developing fetal lung. In our case the severity of pulmonary disease could not be solely explained by prematurity. We concluded that treatment with chemotherapy in second trimester had adverse effects on developing lung that can persist in the first year of life. Further research is needed to evaluate the effect and outcome of chemotherapy given in late gestation on fetal lung development.
Reference #1: Lenhard MS, Bauerfeind I, Untch M : Breast cancer and Pregnancy: challenges of chemotherapy. Crit Rev Oncol Hematol 2008 Sep; 67(3):196-203
Reference #2: Cardonick E, Iacobucci A : Use of chemotherapy during human pregnancy .Lancet Oncol .2004 May; 5(5):283-91
Reference #3: Kerr JR: Neonatal effects of breast cancer chemotherapy administered during pregnancy. Phamacotherapy 2005Mar:25 (3)438-41
DISCLOSURE: The following authors have nothing to disclose: Aneela Bidiwala, Melodi Pirzada, Claudia Halaby
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