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Vol. 6, No. 6, 2011
Issue release date: December 2011
Free Access
Breast Care 2011;6:475–478
(DOI:10.1159/000335202)

Fetal Renal Insufficiency Following Trastuzumab Treatment for Breast Cancer in Pregnancy: Case Report und Review of the Current Literature

Gottschalk I.a · Berg C.a,b · Harbeck N.c · Stressig R.d · Kozlowski P.d
aPränatalmedizin und Gynäkologische Sonographie, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität zu Köln, bBereich Pränatale Medizin, Universitätsfrauenklinik Bonn, cBrustzentrum, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität zu Köln, dpraenatal.de, Pränatal-Medizin und Genetik, Düsseldorf, Germany
email Corresponding Author

Abstract

Some drugs are known for their fetal nephrotoxicity and should be avoided during pregnancy. We report on a pregnant woman suffering from breast cancer who received a weekly neoadjuvant trastuzumab (Herceptin®) therapy from 15 weeks of gestation onward, in addition to a 3-weekly carboplatin/docetaxel chemotherapy. Fetal renal insufficiency with anhydramnios and missing visualization of the fetal bladder developed at 21 weeks. After discontinuation of trastuzumab and repeated instillation of amniotic fluid, the amount of amniotic fluid remained stable after 24 weeks of gestation. After caesarean section at 34 weeks because of fetal growth restriction, the renal function of the neonate was normal postnatally. In accordance with the current literature, our case shows a reversible adverse effect of trastuzumab on the fetal renal function and confirms the current recommendation that trastuzumab in pregnancy should be avoided. In pregnancies exposed to trastuzumab, treatment should be discontinued and the fetus should be closely monitored, with particular attention to the amniotic fluid and the fetal bladder volume, as these reflect fetal renal function.


 Outline


 goto top of outline Keywords

  • Fetus
  • Renal insufficiency
  • Trastuzumab
  • Breast cancer
  • Pregnancy

 goto top of outline Summary

Some drugs are known for their fetal nephrotoxicity and should be avoided during pregnancy. We report on a pregnant woman suffering from breast cancer who received a weekly neoadjuvant trastuzumab (Herceptin®) therapy from 15 weeks of gestation onward, in addition to a 3-weekly carboplatin/docetaxel chemotherapy. Fetal renal insufficiency with anhydramnios and missing visualization of the fetal bladder developed at 21 weeks. After discontinuation of trastuzumab and repeated instillation of amniotic fluid, the amount of amniotic fluid remained stable after 24 weeks of gestation. After caesarean section at 34 weeks because of fetal growth restriction, the renal function of the neonate was normal postnatally. In accordance with the current literature, our case shows a reversible adverse effect of trastuzumab on the fetal renal function and confirms the current recommendation that trastuzumab in pregnancy should be avoided. In pregnancies exposed to trastuzumab, treatment should be discontinued and the fetus should be closely monitored, with particular attention to the amniotic fluid and the fetal bladder volume, as these reflect fetal renal function.

Copyright © 2011 S. Karger AG, Basel


 goto top of outline Author Contacts

Dr. Ingo Gottschalk, Pränatalmedizin und Gynäkologische Sonographie, Klinik und Poliklinik, für Frauenheilkunde und Geburtshilfe der Universität zu Köln, Kerpenerstr. 34, 50931 Köln, Germany, Tel. +49 221 478-4975, Fax -4998, ingo.gottschalk@uk-koeln.de


 goto top of outline Article Information

Published online: December 16, 2011
Number of Print Pages : 4


 goto top of outline Publication Details

Breast Care (Multidisciplinary Journal for Research, Diagnosis and Therapy)

Vol. 6, No. 6, Year 2011 (Cover Date: December 2011)

Journal Editor: Harbeck N. (Köln), Thomssen C. (Halle/Saale), Gnant M. (Wien)
ISSN: 1661-3791 (Print), eISSN: 1661-3805 (Online)

For additional information: http://www.karger.com/BRC


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Some drugs are known for their fetal nephrotoxicity and should be avoided during pregnancy. We report on a pregnant woman suffering from breast cancer who received a weekly neoadjuvant trastuzumab (Herceptin®) therapy from 15 weeks of gestation onward, in addition to a 3-weekly carboplatin/docetaxel chemotherapy. Fetal renal insufficiency with anhydramnios and missing visualization of the fetal bladder developed at 21 weeks. After discontinuation of trastuzumab and repeated instillation of amniotic fluid, the amount of amniotic fluid remained stable after 24 weeks of gestation. After caesarean section at 34 weeks because of fetal growth restriction, the renal function of the neonate was normal postnatally. In accordance with the current literature, our case shows a reversible adverse effect of trastuzumab on the fetal renal function and confirms the current recommendation that trastuzumab in pregnancy should be avoided. In pregnancies exposed to trastuzumab, treatment should be discontinued and the fetus should be closely monitored, with particular attention to the amniotic fluid and the fetal bladder volume, as these reflect fetal renal function.



 goto top of outline Author Contacts

Dr. Ingo Gottschalk, Pränatalmedizin und Gynäkologische Sonographie, Klinik und Poliklinik, für Frauenheilkunde und Geburtshilfe der Universität zu Köln, Kerpenerstr. 34, 50931 Köln, Germany, Tel. +49 221 478-4975, Fax -4998, ingo.gottschalk@uk-koeln.de


 goto top of outline Article Information

Published online: December 16, 2011
Number of Print Pages : 4


 goto top of outline Publication Details

Breast Care (Multidisciplinary Journal for Research, Diagnosis and Therapy)

Vol. 6, No. 6, Year 2011 (Cover Date: December 2011)

Journal Editor: Harbeck N. (Köln), Thomssen C. (Halle/Saale), Gnant M. (Wien)
ISSN: 1661-3791 (Print), eISSN: 1661-3805 (Online)

For additional information: http://www.karger.com/BRC


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.