Use of erlotinib throughout pregnancy: A case-report of a patient with metastatic lung adenocarcinoma

Rivas, Giovanna; Llinás, Néstor; Bonilla, Carlos; Rubiano, Juan; Cuello, Javier; Arango, Natalia

doi:10.1016/j.lungcan.2012.03.026

Cited by 34 publications

(15 citation statements)

References 12 publications

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“…The majority of published cases of NSCLC diagnosed during pregnancy in never or light smokers with molecular testing available harbored EGFR mutations. 15, 16, 17, 18 However, in our series, among the different molecular subgroups, ALK -positive NSCLC predominated. This discrepancy may be explained by the rarity of pregnancy/peripartum diagnosis of NSCLC, the relatively recent identification of ALK as an oncogenic driver, younger age of patients with ALK -positive NSCLC relative to other genotypes, variation in frequency of testing for ALK rearrangements across institutions, referral bias, and reporting bias.…”

Section: Discussioncontrasting

confidence: 56%

“…Treatment with TKIs may account for the improved outcomes seen in our series and recently published case reports. 15, 16, 17, 18, 19, 20 Indeed, most of the patients reported in our series are alive over 2 years after their lung cancer diagnosis (Table 3). Little, however, is known about the safety of targeted agents during pregnancy.…”

Section: Discussionmentioning

confidence: 80%

“…Several reports of successful use of EGFR TKIs during pregnancy have recently been published. 15, 16, 17, 18, 21 These reports demonstrate that despite transplacental transfer of erlotinib and gefitinib, there is limited accumulation of the TKIs. 17, 18,22 Moreover, one study suggests that gefitinib may be preferable to erlotinib for use in pregnant patients with EGFR -mutant NSCLC as erlotinib may cross the placenta at a higher rate than gefitinib.…”

Section: Discussionmentioning

confidence: 89%

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Clinicopathologic Features of NSCLC Diagnosed During Pregnancy or the Peripartum Period in the Era of Molecular Genotyping

Dagogo‐Jack

Gainor

Porter

et al. 2016

Journal of Thoracic Oncology

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Background 1 in 1000 women will be diagnosed with cancer during pregnancy. The outcomes for non-small cell lung cancer (NSCLC) diagnosed during pregnancy are dismal, with most patients dying within one year. Actionable mutations are more likely to be found among younger patients with NSCLC. However, most previous reports of NSCLC diagnosed during pregnancy did not include molecular genotyping. Methods We performed a retrospective analysis of patients seen at our institution between 2009 and 2015 to identify women diagnosed with NSCLC during pregnancy or the peripartum period and determined clinicopathologic features, including molecular genotype. Results We identified 2,422 women with NSCLC, including 160 women of reproductive age. Among the women of reproductive age, eight cases of NSCLC diagnosed during pregnancy or the peripartum period were identified, all of whom were minimal or never-smokers with metastatic adenocarcinoma. Six of these patients were found to have ALK rearrangements, while the remaining two were EGFR mutation-positive. We observed a borderline significant association between a pregnancy/peripartum NSCLC diagnosis and ALK-positivity (p= 0.053). All eight women diagnosed with NSCLC during pregnancy/peripartum received treatment with genotype-directed therapies after delivery. The median overall survival (OS) has not been reached at a median follow-up of 30 months. Conclusions Although a pregnancy/peripartum diagnosis of NSCLC is rare, diagnostic evaluation should not be delayed in pregnant women presenting with symptoms worrisome for lung cancer. Evaluation should include testing for targetable molecular alterations.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 89%

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Clinicopathologic Features of NSCLC Diagnosed During Pregnancy or the Peripartum Period in the Era of Molecular Genotyping

Dagogo‐Jack

Gainor

Porter

et al. 2016

Journal of Thoracic Oncology

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“…However drug administration was initiated without knowledge of ongoing pregnancy as chemotherapy should not be administered during the first trimester because of a high risk of congenital malformations [1] These three cases confirmed a good rate of response and rapid efficacy on respiratory distress associated with no fetal adverse events and a good outcome for children as demonstrated in Table 1 [8][9][10]. Finally, taking into account that TKIs could improve the mother's respiratory distress more efficiently than cytotoxic chemotherapy and thus avoid a immediate fetal extraction and its morbidity, we then urgently began gefitinib treatment for both reasons.…”

Section: Therapeutic Discussionmentioning

confidence: 73%

Efficacy and safety of gefitinib during pregnancy: Case report and literature review

Gil¹,

Goetgheluck²,

Paci³

et al. 2014

Lung Cancer

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“…Medical references describe only two case reports on the use of erlotibinib, both show the occurrence of pregnancy while currently on medication [15,16] each concluding with delivery of a healthy baby.…”

Section: Discussionmentioning

confidence: 99%

Lung cancer in pregnancy

Holzmann

Kropfmüller

Schinko

et al. 2015

Wien Klin Wochenschr

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In the 26th week of gestation, a 29-year-old pregnant office employee was referred to the pulmonary department of Linz General Hospital (AKH) under the suspicion of tuberculosis. She complained of a cough with intermittent hemoptysis and pain in the thoracic spine from which she had been suffering the past 9 weeks. A plain chest X-ray showed a dense infiltrate on the right side and multiple smaller shadows in both lungs. Laboratory testing revealed anemia, leukocytosis, and an increase of C-reactive protein. All tests for tuberculosis were negative.A bronchoscopy was performed and biopsies were taken from the right upper and middle lobe. The histopathological examination found cells of an adenocarcinoma. A magnetic resonance imaging (MRI) revealed a large tumor and surrounding atelectasis were seen in the right upper and middle lobe, as well as multiple intrapulmonary metastases in both lungs. In addition, not only metastases in the thoracic spine (level Th2/3) but also at other osseous locations and multiple cerebral metastases were detected. The patient received one cycle of chemotherapy consisting of docetaxel and carboplatin (AUC5) in the 27th week of gestation. Additional radiotherapy was applied to the involved thoracic spine. Due to positive epidermal growth factor receptor mutation, therapy with gefitinib 250 mg/day was started 2 days after a Caesarean section (preceded by treatment for fetal lung maturation). A healthy girl was delivered in the 30th week of pregnancy. Staging with computed tomography (CT) after delivery revealed an unstable fracture of Th2 with compression of the spinal cord. Neurosurgery was performed, consisting of a ventral corporectomy of Th1-2 followed by an anterior and posterior osteosynthesis for stabilization. The patient was discharged without neurological deficits within 1 week. Subsequent treatment with gefitinib improved the performance status of the patient, and CT scans of the chest and an MRI of the brain showed the size of the tumor to be shrinking. Meanwhile, the infant developed appropriately for her age.After 14 months of the first diagnosis, the patient experienced neurological symptoms (aphasia, confusion) due to neoplastic meningeosis and cerebral venous sinus thrombosis together with local tumor progression in the lung. One course of chemotherapy, combining carboplatin/pemetrexed/bevacizumab, was given without clinical response. Despite best supportive care, the patient died 17 months after diagnosis in October 2013.

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Use of erlotinib throughout pregnancy: A case-report of a patient with metastatic lung adenocarcinoma

Cited by 34 publications

References 12 publications

Clinicopathologic Features of NSCLC Diagnosed During Pregnancy or the Peripartum Period in the Era of Molecular Genotyping

Clinicopathologic Features of NSCLC Diagnosed During Pregnancy or the Peripartum Period in the Era of Molecular Genotyping

Efficacy and safety of gefitinib during pregnancy: Case report and literature review

Lung cancer in pregnancy

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