� Treating breast cancer in pregnant women �

Research works on chemotherapy treatment of breast cancer during pregnancy, run within one of the PremUp Foundation's 'Medication and Pregnancy' Pregmed platforms, received the Alexandre Joël Prize for the Best Poster in the Master 2 category (ex aequo) during the Young Researchers ARC Sessions on 21st October 2010 and on 9th December 2010, it received the Prize for the Best Oral Communication from the French-speaking Obstetrics and Gynaecology Research Sessions (JFROG) within the CNGOF (National College of French Gynaecologists and Obstetricians).
Every year, out of 10,000 pregnancies, one to three pregnant women suffer breast cancer and for some of them, chemotherapy might prove necessary during pregnancy. The question then arises concerning anti-cancer agents used in this type of cancer passing to the foetus. Within Pregmed, Paul Berveiller, houseman at Paris Hospitals (Gynaecology-Obstetrics), is working on two molecules used in breast cancer, paclitaxel and docetaxel, both belonging to the taxane family. These two molecules are currently used indiscriminately in pregnant women due to lack of data concerning how they pass through the placenta.

These works aimed to compare how these two drugs pass towards the foetal sector, in order to provide doctors with essential information on placenta passage of taxanes and so allow them to choose one molecule over another and from there, manipulate these drugs as effectively and safely as possible.

The method used to study this trans-placenta passage of taxanes was the "placenta perfusion" method. This involved perfusing placentas recovered immediately after birth with the molecules in question, whilst reconstituting artificial double maternal and foetal circulation. The criteria studied correspond mainly to comparing the concentration of the molecule in question in the foetal sector and in the maternal sector.

According to initial observations, we can see a relatively low trans-placenta transfer for these two molecules without, however, seeing a significant difference between the two. Of course, the number of placentas studied is restricted and the results are still preliminary but we can already say that, at the doses used in current practices, there is no major difference in terms of trans-placenta transfer between these taxane molecules, in this ex vivo model.

As we can still not draw definitive conclusions regarding real risks for the foetus, these works are going to be coupled to other studies, also run within Pregmed regarding the toxicity of these molecules. Associated with parallel examination of publications concerning forty pregnant patients treated using taxanes during their pregnancy, these first results nevertheless lead us to think that the use of taxanes during pregnancy is feasible in the 2nd and 3rd trimester without notable effects on the foetus.

On a question that is as dramatic for women and very difficult ethically - for the doctor treating her - as cancer during pregnancy, the first results from this scientific research led by PremUp that have just been rewarded by ARC and CNGOF, help to undermine the dogma a little that until recently prohibited treating a pregnant woman with drugs considered as dangerous for her foetus but nevertheless crucial for her own health.

This might provide some hope that we will soon see the use of chemotherapy in breast cancer for pregnant women being rationalised and standardised.