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Breast Care (Basel). 2011 December; 6(6): 475–478.
Published online 2011 December 16. doi:  10.1159/000335202
PMCID: PMC3290009

Language: English | German

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


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.

Keywords: Fetus, Renal insufficiency, Trastuzumab, Breast cancer, Pregnancy


Für einige Medikamente sind fötale, nephrotoxische Nebenwirkungen bekannt, weshalb eine Therapie mit diesen Medikamente während einer Schwangerschaft vermieden werden sollte. Wir berichten von einer Schwangeren mit Brustkrebs, die neoadjuvant ab der 15. Schwangerschaftswoche (SSW) zusätzlich zur 3-wöchentlichen Carboplatin/Doxetaxel-Chemotherapie wöchentlich Trastuzumab (Herceptin®) erhalten hatte. Ab der 21. SSW zeigte sich ein Anhydramnion als Zeichen einer fötalen Niereninsuffizienz. Eine fötale Harnblasenfüllung war nicht darstellbar. Nach sofortigem Absetzen von Trastuzumab und wiederholter wöchentlicher Fruchtwasserauffüllung normalisierte sich die Fruchtwassermenge dann ab der 24. SSW und blieb im Verlauf normal. Im weiteren Verlauf der Schwangerschaft entwickelte sich eine fötale Wachstumsretardierung, die zur Entbindung durch Sectio caesarea in der 34. SSW führte. Die weitere postnatale Entwicklung sowie die Nierenfunktion des Neonaten waren unauffällig. In Übereinstimmung mit bisherigen Publikationen zeigt unser Fall eine Trastuzumab-bedingte, reversible fötale Niereninsuffizienz und bestätigt somit aktuelle Empfehlungen, eine Therapie mit Trastuzumab in der Schwangerschaft zu vermeiden. Nach erfolgter Gabe in der Schwangerschaft sollte Trastuzumab sofort abgesetzt und die weitere Schwangerschaft engmaschig kontrolliert werden, wobei besonderes Augenmerk auf die Fruchtwassermenge und die fötale Harnblasenfüllung gelegt werden sollte, da diese die adäquate fötale Nierenfunktion widerspiegeln.


Breast cancer in pregnant women is rare, with an incidence of 1 in 3000 live births [1, 2, 3]. But with increasingly higher maternal age at time of conception the incidence of malignant diseases in pregnancy is rising. Thus, we are more frequently confronted with the question of compatibility of chemotherapy and pregnancy, and information about possible side effects on the fetus is of increasing clinical relevance [4, 5, 6, 7, 8, 9, 10, 11, 12]. The recent literature describes new therapeutic options for breast cancer 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 administered during the second or third trimester [6, 7, 10, 11, 12, 16, 17, 23, 24, 25, 36, 37, 38].

Case Report

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 signs 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 + 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 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 flow parameters. As the growth restriction worsened, a caesarean section was performed at 33 + 2 weeks and a dystrophic premature male neonate was born (birth weight < 3rd percentile). 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.


Chemotherapy during the first trimester of pregnancy – the time of fetal organogenesis – is associated with an increased incidence of teratogenicity and an increased rate of fetal malformation compared with administration in the second or third trimester [26, 38, 39, 40, 41, 42]. Earlier reports with an association of chemotherapy and fetal growth restriction [26, 38, 39, 40, 41, 42] could not be confirmed in the recent literature [10, 12, 17, 36].

Whether the growth restriction leading to preterm delivery of a dystrophic neonate in our case was caused by the chemotherapeutic drugs, by trastuzumab or neither of them remains unclear. As Doppler sonography failed to demonstrate any sign of uteroplacental dysfunction, it is most likely drug induced.

If chemotherapy during pregnancy is unavoidable, some chemotherapeutic drugs are considered safer than others and should be used preferably: Contraindicated in pregnancy are the folic acid antagonist methotrexate or aminopterin [43, 44, 45, 46, 47, 48, 49], and thus the previously most common adjuvant regimen cyclophosphamide/methotrexate/fluorouracil (CMF) [7]. Other drugs, like the pyrimidine-antagonist 5-fluorouracil, should be avoided during pregnancy because of limited experience in pregnancy [10, 11, 16, 17, 49]. For other drugs, reports are contradictory, e.g. reports on the effect of cyclophosphamide [7, 10, 24, 37, 38, 43, 50, 51]. Until now, the best body of evidence exists for anthracyclines, mostly because these drugs have also been used for a long time in young women with hematological malignancies [7, 10, 11, 25, 27, 28, 38, 52, 53, 54, 55, 56, 57, 58].

In our case, the pregnant woman was exposed to a neoadjuvant docetaxel/carboplatin/trastuzumab regimen. A significant transplacental transfer of platinum-containing drugs like cis- and carboplatin was reported in previous studies from the second trimester of pregnancy onward, but no fetotoxic effect was seen in any of the published cases [51, 29, 30, 31, 59, 60]. Thus, administration of carboplatin during pregnancy seems to be reasonable and the benefits from its use in pregnancy may be acceptable despite a possible risk for the fetus.

The anti-neoplastic effect of taxanes is based on the inhibition of the synthesis of microtubules. Experience with fetal exposition to taxanes shows no adverse effect on the fetus, and exclusively healthy babies were born [18, 19, 20, 21, 22, 23, 26, 30, 31, 33, 34, 61].

Trastuzumab (Herceptin®, Roche Pharma AG, Grenzach-Whylen, Germany) is a monoclonal IgG1 antibody to the human epidermal growth factor receptor HER2. The transplacental transfer of IgG1 antibodies is documented [62] and has been shown for other IgG1 antibodies like rituximab [63] and infliximab [64]. As HER2 is also expressed in embryofetal tissue, it may be critical for fetal development. Now sufficient reports on trastuzumab-therapy in pregnancy have been published in which serious adverse effects on fetal development were documented to show that trastuzumab in pregnancy is contraindicated [3, 10, 13, 15, 16, 17, 32, 35, 65, 66, 67, 68, 69, 70, 71, 72, 73]. Most cases report on fetal nephrotoxicity with renal insufficiency with oligo- and anhydramnios [32, 35, 65, 66, 72], but with spontaneous improvement of renal function after discontinuation of trastuzumab. Another case of trastuzumab in pregnancy showed oligohydramnios and vaginal bleeding at 27 weeks of gestation. A caesarean section was performed subsequently for ongoing bleeding. The preterm infant developed respiratory failure, capillary leak syndrome, persistent infections, and necrotizing enterocolitis and ultimately died [71].

Three other case reports showed uneventful pregnancies without fetal impairment and with normal fetal growth. Each pregnancy resulted in the birth of a healthy baby [67, 68, 69]. Another case described a pregnancy exposed to trastuzumab until 24 weeks of gestation. Therapy was then discontinued because of asymptomatic persistent mildly reduced ejection fraction. The pregnancy was otherwise uneventful. A healthy baby was born at 37 weeks of gestation by caesarean section due to breech presentation. No data on fetal renal function were available [70].


In accordance with the current literature, our case showed a trastuzumab-induced transient fetal renal insufficiency with anhydramnios, with improvement of amniotic fluid volume and complete remission of renal function after discontinuation of trastuzumab. Although HER2 overexpression is a negative marker for maternal prognosis [74, 75] and a combination of chemotherapy with trastuzumab significantly improves maternal survival, therapy in pregnancy should be avoided. If accidentally exposed to trastuzumab, treatment should be discontinued immediately 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.

Disclosure Statement

All authors have no financial or personal conflicts of interest.


1. Wallack MK, Wolf JA, Jr, Bedwinek J, Denes AE, Glasgow G, Kumar B, Meyer JS, Rigg LA, Wilson-Krechel S. Gestational carcinoma of the female breast. Curr Probl Cancer. 1983;7:1–58. [PubMed]
2. Merlob P. Infant or mother with malignant disease. Beltis. 2004;12:40–49.
3. Barnes DM, Newman LA. Pregnancy-associated breast cancer: A literature review. Surg Clin N Am. 2007:417–430. [PubMed]
4. Kelly HL, Collichio FA, Dees EC. Concomitant pregnancy and breast cancer: options for systemic therapy. Breast Dis. 2006;23:2005–2095. [PubMed]
5. Aziz S, Pervez S, Khan S, Siddiqui T, Kayani N, Israr M, Rahbar M. Case control study of novel prognostic markers and disease outcome in pregnancy/lactation-associated breast carcinoma. Pathol Res Pract. 2003;199:15–21. [PubMed]
6. McGrath S, Ring A. Chemotherapy for breast cancer in pregnancy: evidence and guidance for oncologists. Ther Adv Med Oncol. 2011;3:73–83. [PMC free article] [PubMed]
7. Ring AE, Smith IA, Jones A, Shannon C, Galani E, Ellis PA. Chemotherapy for breast cancer during pregnancy: an 18-year experience from five London teaching hospitals. J Clin Oncol. 2005;23:4192–4197. [PubMed]
8. Reed W, Sandstad B, Holm R, Nesland JM. The prognostic impact of hormone receptors and c-erbB-2 in pregnancy-associated breast cancer and their correlation with BRCA1 and cell cycle modulators. Int J Surg Pathol. 2003;11:65–74. [PubMed]
9. German Breast Group, GBG-29: Breast cancer in pregnancy: Prospective register study for the diagnosis and treatment of breast cancer in pregnancy.
10. Loibl S, Amant F, Kaufmann M, Ring A, Han S, Giermek J, Bontenbal M, Heinrigs M, Jenhard M, Mehta K, von Minckwitz G: 313 patients with breast cancer during pregnancy-results from a prospective and retrospective registry (GBG-20/ BIG02-03). San Antonio Breast Cancer Symposium (SABCS) 2010;abstr 259.
11. Hahn KME, Johnson PH, Gordon N. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer. 2006;107:1219–1226. [PubMed]
12. Cardonick E, Usmani A, Ghaffar S. Perinatal outcomes of a pregnancy complicated by cancer, including neonatal follow up after in utero exposure to chemotherapy: results of an international registry. Am J Clin Oncol. 2010;33:221–228. [PubMed]
13. Loibl S, von Minckwitz G, Gwyn K. Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer. 2006;106:237–246. [PubMed]
14. De Carolis S, Grimolizzi F, Garofalo S, Fatigante E, Ferrazzani S, Carducci B, Caruso A. Cancer in pregnancy: results of a series of 32 patients. Anticancer Res. 2006;26:2413–2418. [PubMed]
15. Halaska MJ, Pentheroudakis MD, Strnad P, Stankusova H, Chod J, Robova H, Petruzelka L, Rob L, Pavlidis N. Presentation, management and outcome of 32 patients with pregnancy associated breast cancer: a matched controlled study. Breast J. 2009;15:461–467. [PubMed]
16. Loibl S. New therapeutic options for breast cancer during pregnancy. Breast Care. 2008;3:171–176. [PMC free article] [PubMed]
17. Mir O, Berveiller P, Ropert S, Goffinet F, Pons G, Treluyer JM, Goldwasser F. Emerging therapeutic options for breast cancer chemotherapy during pregnancy. Ann Oncol. 2008;19:607–613. [PubMed]
18. Gonzales-Angulo AM, Walters RS, Carpenter RJ, Ross MI, Perkins GH, Gwyn K, Theriault RL. Paclitaxel chemotherapy in a pregnant patient with bilateral breast cancer. Clin Breast Cancer. 2004;5:317–319. [PubMed]
19. DeSantis M, Lucchese A, De Carolis S, Ferrazzani S, Caruso A. Metastatic breast cancer in pregnancy: first case of chemotherapy with docetaxel. Eur J Cancer. 2000;9:235–237. [PubMed]
20. Gainford MC, Clemons M. Breast cancer in pregnancy: are taxanes safe? Clin Oncol. 2006;18:159. [PubMed]
21. Potluri V, Lewis D, Burton GV. Chemotherapy with taxanes in breast cancer during pregnancy: case report and review of the literature. Clin Breast Cancer. 2006;7:167–170. [PubMed]
22. Nieto Y, Santisteban M, Aramendia JM, Fernandez-Hidalgo O, Garcia-Manero M, Lopez G. Docetaxel administered during pregnancy for inflammatory breast carcinoma. Clin Breast Cancer. 2006;6:533–534. [PubMed]
23. Gadducci A, Cosio S, Fanucchi A, Nardini V, Roncella M, Conte PF, Genazzani AR. Chemotherapy with epirubicin and paclitaxel for breast cancer during pregnancy: case report and review of the literature. Anticancer Res. 2003;23:5225–5229. [PubMed]
24. Koren G, Weiner L, Lishner, M, Zemelickes D, Fingegen J. Cancer and pregnancy: identification of unanswered questions on maternal and fetal risks. Obstet Gynecol Surv. 1990;45:509–514. [PubMed]
25. Germann N, Goffinet F, Goldwasser F. Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients. Ann Oncol. 2004;15:146–150. [PubMed]
26. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5:283–291. [PubMed]
27. Arlin Z, Case DC, Jr, Moore J, Wiernik P, Feldman E, Saletan S, Desai P, Sia L, Cartwright K. Randomized multicenter trial of cytosine arabinoside with mitoxantrone or daunorubicin in previously untreated adult patients with acute nonlymphocytic leukaemia (ANLL) Leukemia. 1990;4:177–183. [PubMed]
28. Büchner T, Hiddemann W, Wörmann B, et al. Double induction strategy for acute myoloid leukaemia: the effect of high-dose cytarabine with mitoxantrone instead of standard-dose cytarabine with daunorubicin and 6-thioguanine: a randomized trial by the German AML Cooperative Group. Blood. 1999;93:4116–4124. [PubMed]
29. Mir O, Berveiller P, Ropert S, Goffinet F, Goldwasser J. Use of platinum derivates during pregnancy. Cancer. 2008;11:3069–3074. [PubMed]
30. Mendez LE, Mueller A, Salom E, Gonzalez-Quintero VH. Paclitaxel and carboplatin chemotherapy administered during pregnancy for advanced epithelial ovarian cancer. Obstet Gynecol. 2003;102:1200–1202. [PubMed]
31. Sood AK, Shahin MS, Sorosky JI. Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy. Gynecol Oncol. 2001;83:599–600. [PubMed]
32. Bader AA, Schlembach D, Tamussino KF, Pristauz G, Petru E. Anhydramnios associated with administration of trastuzumab and paclitaxel for metastatic breast cancer during pregnancy. Lancet Oncol. 2007;8:79–81. [PubMed]
33. Lycette JL, Dul CL, Munar M, Belle D, Chui SY, Koop DR, Nichols CR. Effect of pregnancy on the pharmacokinetics of paclitaxel: a case report. Clin Breast Cancer. 2006;7:342–344. [PubMed]
34. Gainfort MC, Clemons M. Breast cancer in pregnancy: are taxanes safe? Clin Oncol. 2006;18:159. [PubMed]
35. Sekar R, Stone PR. Trastuzumab use for metastatic breast cancer in pregnancy. Obstet Gynecol. 2007;110:507–510. [PubMed]
36. Cardonick E, Dougherty R, Grana G, Gilmandyar D, Ghaffar S, Usmani A. Breast cancer during pregnancy: maternal and fetal outcomes. Cancer J. 2010;16:76–82. [PubMed]
37. Paladini D, Vassallo M, D'Armiento MR, Cianciaruso B, Martinelli P. Prenatal detection of multiple fetal anomalies following inadvertent exposure to cyclophosphamide in the first trimester of pregnancy. Birth Defects Res A. 2004;70:99–100. [PubMed]
38. Berry DL, Theirault RL, Holmes FA, Parisi VM, Booser DJ, Singletary SE, Buzdar AU, Hortobagyi GN. Management of breast cancer during pregnancy using a standardized protocol. J Clin Oncol. 1999;17:855–861. [PubMed]
39. Schapira DV, Chudley AE. Successful pregnancy following continuous treatment with combination chemotherapy before conception and throughout pregnancy. Cancer. 1984;54:800–803. [PubMed]
40. Doll DC, Ringenberg QS, Yarbo JW. Antineoplastic agents and pregnancy. Semin Oncol. 1989;16:337–346. [PubMed]
41. Giacalone PL, Laffargue F, Benos P. Chemotherapy for breast carcinoma during pregnancy: A French national survey. Cancer. 1999;86:2266–2272. [PubMed]
42. Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Burke B, Sutcliffe SB, Koren G. Maternal and fetal outcome after breast cancer in pregnancy. Am J Obstet Gynecol. 1992;166:781–787. [PubMed]
43. Vaux KK, Kahole NCO, Jones KL. Cyclophosphamide, methotrexate and cytarabine embryopathy: Is apotosis the common pathway? Birth Defects Res A. 2003;67:403–408. [PubMed]
44. Melzer HJ. Congenital anomalies due to attempted abortion with 4-amino pteroylglutamic acid. JAMA. 1956;161:1253. [PubMed]
45. Milunsky A, Graef JW, Gaynor MF. Methotrexate-induced congenital malformations. J Pediatr. 1968;72:790–795. [PubMed]
46. Warkary J. Aminopterin und methotrexate: folic acid deficiency. Teratology. 1978;17:353–358. [PubMed]
47. Bawle EV, Conard JV, Weiss L. Adult and two children with fetal methotrexate syndrome. Teratology. 1998;57:51–55. [PubMed]
48. McElhatton PR. A review of the reproductive toxicity of methotrexate in human pregnancy. Reprod Toxicol. 2000;14:549.
49. Paskulin GA, Gazzola Zen PR, Camargo Pinto LL, Rosa R, Graziadio C. Combined chemotherapy and teratogenicity. Birth Defects Res A. 2005;73:634–637. [PubMed]
50. Zemlickis D, Lishner M, Ehrlich R, Koren G. Teratogenicity and carcinogenicity in a twin exposed in utero to cyclophosphamide. Teratogen Carcinog Mutagen. 1992;13:139–143. [PubMed]
51. Ohara N, Teramoto K. Successful treatment of an advanced cystadenocarcinoma in pregnancy with cisplatin, adriamycin and cyclophosphamid (CAP) regimen. Case report. Clin Exp Obstet Gynecol. 2000;2:123–124. [PubMed]
52. Rai KR, Holland JF, Glidewell OJ, et al. Treatment of acute myelocytic leukemia: a study by the Cancer and Leukemia Group. Blood. 1981;58:1203–1212. [PubMed]
53. Löwenberg B, Downing JR, Burnett A. Acute myeloid leukaemia. N Engl J Med. 1999;341:1051–1062. [PubMed]
54. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, Lister TA, Bloomfield CD. The World Health Organization classification of neoplasms of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol. 1999;17:3835–3849. [PubMed]
55. Bonadonna G, Zucali R, Monfardini S, deLena M, Uslenghi C. Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer. 1975;36:252–259. [PubMed]
56. Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med. 2003;348:2386–2395. [PubMed]
57. Aviles A, Neri N. Hematological malignancies and pregnancy: A final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001;3:173–177. [PubMed]
58. Turchi JJ, Villasis C. Anthracycline in the treatment of malignancy in pregnancy. Cancer. 1988;61:435–440. [PubMed]
59. Han Jung-Yeo, Nava-Ocampo AA, Kim T-J. Pregnancy outcome after prenatal exposure to bleomycin, etoposide and cisplatin for malignant ovarian germ cell tumors: report of 2 cases. Reprod Toxicol. 2005;19:557–561. [PubMed]
60. Peres RM, Sanseverino MTV, Guimararaes JLM, Coser V, Giuliani L, Moreira RK, Ornsten T, Schüler-Faccini L. Assessment of fetal risk associated with exposure to cancer chemotherapy during pregnancy: a multi-center study. Braz J Med Biol Res. 2001;34:1551–1559. [PubMed]
61. Mantovani G, Gramignano G, Mais V. Use of chemotherapy for ovarian cancer during human pregnancy: case report and literature review. Eur J Obstet Gynecol Reprod Biol. 2007;131:238–239. [PubMed]
62. Simister NE. Placental transport of immunoglobulin G. Vaccine. 2003;21:3365–3369. [PubMed]
63. Friedrichs B, Tiemann M, Salwender H, Verpoort K, Wenger MK, Schmitz N. The effects of rituximab treatment during pregnancy on a neonate. Haematologica. 2006;91:1426–1427. [PubMed]
64. Vasiliauskas EA, Church JA, Silverman N, Barry M, Targan ST, Dubinsky MC. Case report: evidence for transplacental transfer of maternally administered infliximab to the newborn. Clin Gastroenterol Hepatol. 2006;4:1225–1228. [PubMed]
65. Watson WJ. Herceptin (trastuzumab) therapy during pregnancy: association with reversible an-hydramnions. Obstet Gynecol. 2005;105:642–651. [PubMed]
66. Pant S, Landon MB, Blumenfeld M, Farrar W, Shapiro CL. Treatment of breast cancer with trastuzumab during pregnancy. J Clin Oncol. 2008;26:1567–1569. [PubMed]
67. Fanale MA, Uyei AR, Theriault RL, Adam K, Thompson RA. Treatment of metastatic breast cancer with trastuzumab and vinorelbine during pregnancy. Clin Breast Cancer. 2005;6:354–356. [PubMed]
68. Waterston AM, Graham J. Effect of adjuvant trastuzumab on pregnancy. J Clin Oncol. 2006;24:321–322. [PubMed]
69. Azim HA, Jr, Peccatori FA, Liptrott SJ, Catania C, Goldhirsch A. Breast cancer and pregnancy: how safe is trastuzumab? Nat Rev Clin Oncol. 2009;6:367–370. [PubMed]
70. Shrim A, Garcia-Bournissen F, Maxwell C, Farine D, Kore G, Favorabl D. pregnancy outcome following trastuzumab (herceptin) use during pregnancy-Case report and updated literature review. Reprod Toxicol. 2007;23:611–613. [PubMed]
71. Witzel ID, Müller V, Harps E, Janicke F, Dewit M. Trastuzumab in pregnancy associated with poor fetal outcome. Ann Oncol. 2008;19:191–192. [PubMed]
72. Beale JM, Tuohy J, McDowell SJ. Herceptin (trastuzumab) therapy in a twin pregnancy with associated oligohydramnios. Am J Obstet Gynecol. 2009;201:e13–e14. [PubMed]
73. Barthelmes L, Gateley CA. Tamoxifen and pregnancy. Breast. 2004;13:446–451. [PubMed]
74. Slamon DJ, Clark GM, Wong SG, Levin WJ, Ullrich A, McGuire WL. Human breast cancer: correlation of relapse and survival with amplification of HER2/neu oncogene. Science. 1987;235:177–182. [PubMed]
75. Sotiron C, Pusztai L. Molecular origin of cancer gene-expression signatures in breast cancer. N Engl J Med. 2009;360:790. [PubMed]

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