Chemotherapie in der Schwangerschaft

In the majority of women diagnosed with breast cancer in pregnancy adjuvant or neoadjuvant chemotherapy is indicated. Administration of chemotherapy should not start before 14 weeks of gestation when fertilization, implantation and organogenesis have been completed. An earlier start with cytotoxic drugs results in a higher rate of miscarriage, fetal death and major malformations. The use of anthracyclines and taxanes is possible in the second and third trimester. These substances seem to have a good safety profile but there is a need for more data about the long-term outcome in children with prenatal exposure to chemotherapy, particularly about a higher risk for malignancies, sterility and cardiotoxicity. Trastuzumab is currently not recommended in any trimester during pregnancy.