Combination chemotherapy and radiation for stage IV breast cancer during pregnancy

A 42-year-old woman presented with a 25-week pregnancy and stage IV breast cancer with metastases in the skeleton and liver and a T-4 primary tumor. She was treated with two cycles of doxorubicin, methotrexate, and vincristine. Spontaneous labor resulted in a normal female infant, who was successfully treated for sepsis and mild respiratory distress. The placenta showed diffuse chorioamnionitis. There was no doxorubicin demonstrated in the placenta, blood, or fetal lymphocytes 3 weeks after the last treatment. Maternal and fetal chromosomal analyses were unremarkable. The child is functioning normally 2 years after delivery. The literature on anthracycline treatment during pregnancy is reviewed. Adriamycin has been shown to cross the blood-placenta barrier, but has not led to specific fetal abnormalities when given during the second or third trimester. Experience during the first trimester is still limited.