Wir berichten von einer Schwangeren mit Brustkrebs, die neoadjuvant ab der 15. In accordance with the current literature, our case shows a reversible adverse effect of trastuzumab around the fetal renal function and confirms the current recommendation that trastuzumab in pregnancy should be avoided. In pregnancies NS11394 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. Keywords:Fetus, Renal insufficiency, Trastuzumab, Breast cancer, Pregnancy == Abstract == Fr einige Medikamente sind ftale, nephrotoxische Nebenwirkungen bekannt, weshalb eine Therapie mit diesen Medikamente whrend einer Schwangerschaft vermieden werden sollte. Wir Rabbit Polyclonal to KITH_HHV1C berichten von einer Schwangeren mit Brustkrebs, pass away neoadjuvant ab der 15. Schwangerschaftswoche (SSW) zustzlich zur 3-wchentlichen Carboplatin/Doxetaxel-Chemotherapie wchentlich Trastuzumab (Herceptin) erhalten hatte. Ab der 21. SSW zeigte sich ein Anhydramnion als Zeichen einer ftalen Niereninsuffizienz. Eine ftale Harnblasenfllung war nicht darstellbar. Nach sofortigem Absetzen von Trastuzumab und wiederholter wchentlicher Fruchtwasserauffllung normalisierte sich pass away Fruchtwassermenge dann ab der 24. SSW und blieb im Verlauf normal. Im weiteren Verlauf der Schwangerschaft entwickelte sich eine ftale Wachstumsretardierung, pass away zur Entbindung durch Sectio caesarea in der 34. SSW fhrte. Die weitere postnatale Entwicklung sowie pass away Nierenfunktion des Neonaten waren unauffllig. NS11394 In bereinstimmung mit bisherigen Publikationen zeigt unser Fall eine Trastuzumab-bedingte, reversible ftale Niereninsuffizienz und besttigt somit aktuelle Empfehlungen, eine Therapie mit Trastuzumab in der Schwangerschaft zu vermeiden. Nach erfolgter Gabe in der Schwangerschaft sollte Trastuzumab sofort abgesetzt und pass away weitere Schwangerschaft engmaschig kontrolliert werden, wobei besonderes Augenmerk auf pass away Fruchtwassermenge und pass away ftale Harnblasenfllung gelegt werden sollte, da diese pass away adquate ftale Nierenfunktion widerspiegeln. == Introduction == Breast malignancy in pregnant women is usually rare, with an incidence of 1 1 in 3000 live births [1,2,3]. But with progressively higher maternal age at time of conception the incidence of malignant diseases in pregnancy is usually rising. Thus, we are more frequently confronted with the question of compatibility of chemotherapy and pregnancy, and information about possible side effects around the fetus is usually of increasing clinical relevance [4,5,6,7,8,9,10,11,12]. The recent literature explains new therapeutic options for breast malignancy during pregnancy and proves the feasibility and tolerability of, e.g., anthracycline- or taxane-containing regimens without compromising the fetus [3,6,7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35], especially if chemotherapy is usually administered during the second or third trimester [6,7,10,11,12,16,17,23,24,25,36,37,38]. == Case Statement == A 38-year-old pregnant woman at 11 + 6 weeks of gestation was diagnosed with an estrogen receptor (ER)/progesterone receptor (PR)-positive, HER2-overexpressing invasive ductal carcinoma of the breast with ductal carcinoma in situ, without further indicators of metastatic disease. According to the patient’s request, breast-conserving surgery and axillary lymph node dissection were postponed until after delivery. Instead, the decision for neoadjuvant chemotherapy with 3-weekly docetaxel (75 mg/m2) and carboplatin (area under the curve (AUC) 6) (q21d) in addition to weekly trastuzumab (Herceptin, 4 mg/kg) (Breast Cancer International Research Group (BCIRG)006) was made by the attending, nonlocal physician, and the first and second cycles of taxotere, carboplatin, Herceptin (TCH) were administered at 14 + 6 and 17 NS11394 + 6 weeks of gestation, respectively, until the patient was referred to our department at 20 + 4 weeks of gestation with anhydramnios and failure to visualize the fetal bladder. As fetal renal insufficiency was suspected, we discontinued trastuzumab therapy immediately and performed weekly instillations of amniotic NS11394 fluid, as the normal amount of amniotic fluid is crucial for fetal lung maturation and development. After 3 instillations, the amount of amniotic fluid remained stable after 24 weeks of gestation. Simultaneously, neoadjuvant chemotherapy was continued externally again, with docetaxel and carboplatin at 21 + 0, 24 + 0, 27 + 0 and 30 + 0 weeks of gestation. At 28 weeks of gestation, fetal growth restriction was diagnosed with normal amniotic fluid volume and normal fetal Doppler circulation parameters. As the growth restriction worsened, a caesarean section was performed at 33 + 2 weeks and a dystrophic premature male neonate was born (birth excess weight < 3rdpercentile). The neonatal period was characterized by inconspicuous neonatal development and normal renal function with normal urinalysis. 13 days post partum, the mother underwent lumpectomy of 2 tumor-free lymph nodes. == Conversation == Chemotherapy during the first trimester of pregnancy the time of fetal organogenesis is usually associated with an.