Dear Laura,

Here's is what Dr. Hale reports in the 2019 copy of "Medications and Mothers' Milk:

Flourouracil - It is an "L4 due to limited data." "Those receiving topical therapy would not need to discontinue breastfeeding if the surface area is minimal. If large body areas were exposed to this therapy, significant absorption could occur."  The half-life is reported to be 16 minutes with IV administration.  He recommends caution with it's use, although no pediatric concerns have been reported.  

Imiquimod - It is an "L3 - probably compatible."  He does mention it has been used in young children, ages 2-12 years of age.  "While there are no data on the excretion of imiquimod into human milk, milk levels will likely to be far lower than 323 ng/L, which would be far too low to produce clinical effects in an infant."  Under "Infant monitoring" he states "vomiting and poor feeding."

Is there a reason why they are treating topically rather than surgically?

My best to your daughter,

Cindy Garrison BS IBCLC 

> Date:    Wed, 15 Jan 2020 11:25:46 -0800
> From:    Laura Monin <[log in to unmask]>
> Subject: TOPICAL DRUGS FOR CANCEROUS SPOT
> 
> Dear Lactnetters,
> 
> If any of you have experience with the 2 drugs: Fluorouracil and Imiquimod please contact me.
> 
> Also, my post to Dr. Hale was undeliverable as sent. Can anyone help me to resend?
> 
> Thank you all,
> 
> Laura Monin
> 
> >>> Dear Dr. Hale and associates,
> >>> 
> >>> This question concerns the above TOPICAL meds suggested to my 39 yo daughter who is currently breastfeeding a 10 week old.
> >>> 
> >>> I have read the commentary on both meds in the 2017 edition of Medications and Mothers Milk. I have used the many edtions as a resource in my 32 year career as an IBCLC. 
> >>> My daughter has been diagnosed with a 1/2 inch X 1/2 inch cancerous spot on her upper forehead. By my math calculations this would be 1/4 square inches or 1.613 square centimeters.
> >>> 
> >>> Despite treatment with the prescribed TX (topical application once a day,  5X/week for 6 weeks), and the fact that this TINY TX area can be kept far away from contact with her infant, her pediatrician has not given her the OK and therefore the dermatologist won’t prescribe the meds.   It has instead been suggested that she “pump and dump“ and feed formula during the 6 weeks of treatment. In an infant this young, 6 weeks of not breastfeeding would inevitably lead to breast refusal and weaning.  
>         
>         Can you suggest any other sources including possible updates in more recent Medications and Mothers Milk that she can share with her pediatrician and dermatologist?
> 
> 	Thank you,
> 
> 	Laura Monin (IBCLC 1985-2017)
> 	[log in to unmask] <mailto:[log in to unmask]>
> 	(925) 631-6667
> 
> 
> 
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