Breast cancer is the second type of cancer worldwide and the most common cancer in women both in the developed and less developed world. It is estimated that worldwide over 508 000 women died in 2011 due to breast cancer (Global Health Estimates, WHO 2013). Nearly 1.7 million new cases were diagnosed in 2012. This represents about 12 percent of all new cancer cases and 25 percent of all cancers in women, states the Worlwide Cancer research Fund International.
When cancer is diagnosed in an expecting mother, the decision whether or not to start chemotherapy during the pregnancy needs to strike a delicate balance between the well-being of the mother and that of the foetus. With ERC support, Dr Frédéric Amant is developing a standard, integrated approach for cancer care for pregnant women. Cancer in pregnancy is increasingly prevalent (1 to 2 in 2000 pregnancies in Europe), largely because of the recent trend to delay childbearing until a later age.
Out of scope
In the last 50 years, drug regulation has significantly evolved. Pregnant women and their foetuses remained out of scope, due to the general reluctance of pharmaceutical companies and expectant mothers to engage in dedicated drug trials. While there is not yet evidence about the potential toxicity of chemotherapy on the foetus, as a precaution, this type of treatment has been largely avoided for pregnant women. Such approach generally led to delay in treatment, termination of pregnancy or premature induction of delivery.
Dr Frédéric Amant from the KU Leuven, in Belgium believes this creates the need and the opportunity to investigate the true relationship between chemotherapy and childbearing with the objective of developing evidence-based rather than opinion-based decision-making.
Robust new evidence
A pilot study led by Dr Amant back in 2012 showed that antenatal exposure to chemotherapy could overall be considered to be safe. This finding was internationally recognized as a first step towards a standard of care for women with cancer during pregnancy. With an ERC Consolidator grant and the support of a multidisciplinary team of experts, Dr Amant is now securing robust evidence about the risk/safety profile for foetuses under mothers’ chemotherapy.
The strength of this project lies in the integrated approach to this multifaceted problem of cancer in pregnancy, with two innovative methodological focus points:
- The use of an international patient registry of young women with cancer with a subregistry of women with pregnancy-associated breast cancer (the INCIP);
- The consultation of extensive biobanks.
Large-scale clinical follow-up studies
This allows for unprecedented large-scale clinical follow-up studies as well as laboratory studies on patient biomaterial, Armant states. In addition, Amant and his team foresee the application of cutting-edge models of human placental research to investigate the physiological basis of the placental barrier function.
The researchers hope the study will be a major step forward to the well-being of both mother and foetus in a pregnancy complicated by cancer, leading to the development of standard diagnostic and therapeutic approaches during this critical period. In addition, the findings could provide substantial impetus to further research in this emerging field.