CASE DESCRIPTION: The patient was a 35-year-old female with a history of
breast cancer (
estrogen receptor/
progesterone receptor negative,
human epidermal growth factor receptor 2/neu positive, status post-neoadjuvant
docetaxel/
carboplatin/
trastuzumab/
pertuzumab therapy, status post-bilateral
mastectomies), and prior right frontal
brain metastases (status post-resection,
capecitabine/
lapatinib/
temozolomide therapy, and cyberknife treatment). Patient was found to be pregnant at 9 weeks' gestation while on
chemotherapy; the patient elected to continue with the pregnancy and
chemotherapy was discontinued. At 14 weeks' gestation, she returned with recurrent right frontal disease. She was taken for a
craniotomy at 16 weeks' gestation, which confirmed
metastases. Six weeks later, patient returned with worsening
headaches and
fatigue, with more recurrent right frontal disease. She was started on decadron and
chemotherapy (
5-fluorouracil,
adriamycin, and
cyclophosphamide). Serial magnetic resonance imaging (MRI) demonstrated enlarging right frontal lesions. She underwent a
craniotomy at 27 weeks' gestation, and
chemotherapy was discontinued promptly. Starting at 30 weeks' gestation, she received whole brain radiation for 2 weeks. Subsequently, she delivered a baby girl via
cesarean section at 32 weeks' gestation. At 6 weeks follow-up, an MRI brain demonstrated no new intracranial disease, with stable postoperative findings.
CONCLUSION: There is a lack of guidelines and clinical consensus on medical and surgical treatment for
breast cancer metastases in pregnant patients. Treatment usually varies based upon underlying
tumor burden, location, gestational age of the fetus, and patient's preference and symptomatology.