Clinical features and intervention timing in patients with pregnancy-associated non-small-cell lung cancer

Abstract

Background: There is no standard procedure available to diagnose and treat with pregnancy-associated non-small-cell lung cancer (NSCLC). The present study was to investigate the clinical and molecular features, and the proper intervention timing for this population. Methods: This is a retrospective, pooled analysis. Cases from Guangdong Lung Cancer Institute and other published cases were collected and reviewed. The overall survival (OS) was analyzed according to the diagnosis timing, the treatment timing and the molecular character. The safety profile during pregnancy was also evaluated. Results: Seventy-seven cases were collected including 11 patients from our center. The anaplastic lymphoma kinase (ALK) gene rearrangement and epidermal growth factor receptor (EGFR) mutation rates were 47% and 32%, respectively. The OS of patients treated during pregnancy, after delivery, and those not treated differed significantly [12 months vs. not reached (NR) vs. 1 month; P<0.001]. However, the OS between patients treated during pregnancy and after delivery was similar (P=0.173). Patients with ALK or EGFR exhibited a significantly better OS than those with wild-type [NR vs. 22 months vs. 8 months; P<0.001; hazard ratio (HR) =0.02, 95% confidence interval (CI): 0.00-0.22; HR =0.08, 95% CI: 0.01-0.76].Fetal complications were observed in babies whose mothers were treated during pregnancy. Conclusions: The pregnancy-associated NSCLC population exhibited a high prevalence of driver genes and a promising effect of targeted therapy. No significant difference in the OS was observed between patients treated during pregnancy and patients treated after delivery.

Lung Adenocancer in Pregnancy and Review of the Literature

“…6 Pregnancy-associated lung cancer is defined as lung cancer detected during pregnancy and within 1 year after birth. In a retrospective analysis by Yang Lei et al, 2 including clinical manifestations, treatments, and outcomes, the median age of 77 pregnancy-related lung cancer cases reported up to 2021 was 34. 20% of the patients had a history of smoking.…”

“…1 Its incidence increases in smokers and advanced-age pregnancies. 2 With the increasing trend of smoking in the young population, its incidence is also increasing at younger ages, and the majority of these cases are stages III or IV lung cancer with a poor prognosis. 3 We present a 36-year-old, 30-week pregnant, passive smoker who was diagnosed with lung adenocarcinoma, had severe biomass exposure, and received chemotherapy and radiotherapy after pregnancy.…”

Placental and Breast Metastasis of Squamous Cell Carcinoma in a Patient With Recurrent Respiratory Papillomatosis

“…Fewer than 80 cases of metastasis to the products of conception (POC), i.e., fetus or placenta, have ever been reported [15]. Approximately 20% of placental metastasis is due to lung cancer, suggesting that lung cancers have a relatively high predilection for the POC [15][16][17]. Indeed, placental growth factors and matrix metalloproteinases have been implicated in the invasion of non-small-cell lung cancer into the placental tissues, facilitating sequestration in the intervillous space [18].…”

Case Report: Termination of unplanned pregnancy led to rapid deterioration of non-small-cell lung cancer during osimertinib treatment

“…In this case, three questions have arisen for our consideration. First is the efficacy and safety of drugs previously reported in patients with pregnancy-related driver gene-positive lung cancer, whether treated accordingly during pregnancy or after delivery, as compared to previous studies ( 15 , 16 ). However, we noted that our report differed from previous cases, as most previous cases were diagnosed with lung cancer after pregnancy, whereas we reported an unplanned pregnancy during lung cancer treatment.…”