A Case of a Pregnant Woman Diagnosed as HavingALK-rearranged Lung Adenocarcinoma

Abstract

A 28-year-old woman who was 34 weeks pregnant was admitted with complaints of cough and blood-stained sputum. After delivery of the baby at 37 weeks gestation, computed tomography and magnetic resonance imaging revealed a tumor in the right lung and a 15-mm brain metastasis. A diagnosis of lung adenocarcinoma was made, cT4N3M1b (stage IV disease) by pleural fluid cytology. Additional testing for anaplastic lymphoma kinase (ALK) fusion protein showed a strongly positive result, which was then confirmed by fluorescence in situ hybridization. The patient was started on treatment with alectinib, and the tumor and brain metastasis had almost vanished by 2 months after the start of this treatment. In the literature, there are 59 reports of lung cancer diagnosed during pregnancy, including two cases of cancer with expression of ALK fusion protein and five cases showing epidermal growth factor receptor mutation. The type of mutation should be taken into consideration while selecting for the appropriate therapeutic strategy.

A pregnant patient with ALK‑positive non‑small cell lung cancer treated with alectinib: A case report and review of the literature

“…Over the last years, cancer incidence among pregnant women is increasing due to a high rate of smokers and an increased maternal age (20)(21)(22)(23)(24). Although mild side-effects with this targeted therapy are observed, pregnancy is discouraged considering the fetal toxicity observed in preliminary animal studies.…”

“…Although mild side-effects with this targeted therapy are observed, pregnancy is discouraged considering the fetal toxicity observed in preliminary animal studies. Regarding the paucity of these cancers during pregnancy, these treatments are currently not recommended (22).…”

Unplanned pregnancy in an HIV positive woman undergoing alectinib treatment for metastatic non-small-cell lung carcinoma

“…We found 61 reports of NSCLC in pregnant women in the literature. Among these, 4 and 5 women presented with ALK and epithelial growth factor receptor (EGFR) gene mutations, respectively 12. A retrospective analysis of cases of NSCLC diagnosed during pregnancy or the peripartum period suggested an increased frequency of ALK mutations during pregnancy while EGFR mutations were the most frequent mutations across all lung adenocarcinoma 3 13…”

“…To our knowledge, this is the first reported case of unplanned pregnancy during alectinib treatment. Among the four patients previously described with metastatic lung cancer who presented ALK mutations, only one patient was treated with ALK-tyrosine kinase inhibitor crizotinib during pregnancy, while the others were not treated or were treated after childbirth, including one patient treated with alectinib but only after the delivery 12 20 21…”