Use of tyrosine kinase inhibitors during pregnancy for oncogenic-driven advanced non-small cell lung carcinoma

Grausz, Noémie; Selleret, Lise; Gligorov, Joseph; Thomassin‐Naggara, Isabelle; Touboul, Cyril; Daraı̈, Émile; Cadranel, Jacques

doi:10.1016/j.lungcan.2021.09.001

Cited by 12 publications

(10 citation statements)

References 41 publications

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“…Another case from Belgium reported a shorter 32 weeks of in utero exposure of alectinib 12. A third case from France involved a very short duration of in utero exposure of alectinib (22 days only) 13. Boudy et al 13 also identified three additional cases where patients received short courses (3–5 weeks) of first-generation ALK inhibitors (crizotinib or ceritinib) for ALK-rearranged metastatic NSCLC during pregnancy 13–15.…”

Section: Discussionmentioning

confidence: 99%

“…A third case from France involved a very short duration of in utero exposure of alectinib (22 days only) 13. Boudy et al 13 also identified three additional cases where patients received short courses (3–5 weeks) of first-generation ALK inhibitors (crizotinib or ceritinib) for ALK-rearranged metastatic NSCLC during pregnancy 13–15. In contrast, at least eight published case reports identified by Boudy et al 13 involved expediting delivery, sometimes with induced premature delivery, to allow initiation of indicated TKI therapy in the postpartum setting 12…”

Section: Discussionmentioning

confidence: 99%

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Treating anaplastic lymphoma kinase (ALK) fusion-driven metastatic non-small cell lung cancer (NSCLC) with alectinib through pregnancy

Wu,

Rittberg,

Lim

et al. 2024

BMJ Case Rep

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Management of cancer during pregnancy requires careful consideration of risks and benefits from maternal and fetal perspectives. For advanced lung adenocarcinomas, with no targetable driver mutations, there is evidence-based guidance on the use of carboplatin–paclitaxel chemotherapy after first trimester. In contrast, for epidermal growth factor receptor (EGFR)-mutated or anaplastic lymphoma kinase (ALK)-rearranged metastatic lung adenocarcinomas, there is a paucity of clinical data on the safety of EGFR and ALK tyrosine kinase inhibitors to mother and fetus for official guidelines to recommend the use of these otherwise-first-line therapies in pregnancy. Considering this knowledge gap, we present a case of a young gravida 1 para 0 (G1P0) woman who continued alectinib 300 mg oral two times per day for ALK-rearranged metastatic lung adenocarcinoma throughout all 36 weeks of her pregnancy and delivered a healthy baby at term via caesarean section (C-section).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treating anaplastic lymphoma kinase (ALK) fusion-driven metastatic non-small cell lung cancer (NSCLC) with alectinib through pregnancy

Wu,

Rittberg,

Lim

et al. 2024

BMJ Case Rep

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“…Likewise, the feto-maternal interface, especially the brush border, has a high density of EGFRs, a pathway that contributes to placental endocrine functions. The lack of EGFR or truncated forms of the receptor in placental tissues has been associated with intrauterine growth retardation, underscoring the importance of this pathway in the correct functioning and development of the fetoplacental unit (16).…”

Section: Discussionmentioning

confidence: 99%

“…Five of the patients were diagnosed with LC before conception and have received TKI as treatment during pregnancy. IUGR and oligohydramnios were observed but without detrimental effects on the fetus and no signs of neonatal toxicity (16). Thus, considering the clinical benefit provided by targeted therapy, EGFR-TKIs could be considered during pregnancy, at least after the second trimester.…”

Section: Discussionmentioning

confidence: 99%

Case report: Osimertinib administration during pregnancy in a woman with advanced EGFR-mutant non-small cell lung cancer

et al. 2023

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Lung cancer (LC) is one of the most common causes of death worldwide. The identification of oncogene-addicted driving mutations suitable for targeted therapy has improved clinical outcomes in advanced diseases. Clinical trials, on the other hand, rarely involve vulnerable groups such as pregnant women. We report a 37-year-old woman with advanced non-small cell lung cancer (NSCLC) harboring an exon 19 deletion of EGFR treated with afatinib. After the initial treatment, the patient achieved a complete response and had an unplanned pregnancy. Targeted therapy was withheld during the first trimester and resumed with osimertinib in the second trimester in which the patient developed oligohydramnios and intrauterine growth restriction (IUGR) of the baby. Osimertinib was delayed at two different times during the third trimester with complete resolution of the oligohydramnios. The baby was born at 37.3 weeks of gestation (WOG) with no signs of congenital disorders. After delivery, the mother restarted osimertinib and maintained a complete response. This case suggests that osimertinib could be an acceptable option for tumor control during pregnancy in EGFR-mutant NSCLC. This information do not replace current recommendations for avoiding pregnancy and promoting contraceptive usage in patients receiving any cancer therapy.

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“…The use of molecular-targeted drugs for epidermal growth factor receptor (EGFR)- or ALK-positive lung cancer patients during pregnancy has been reported in several cases. 16 Only one case has been reported of a patient with metastatic lung cancer who continued treatment with alectinib and delivered a healthy baby at 35 weeks without disease progression. 17 This suggests that the use of molecular-targeted drugs during pregnancy is an option with extended follow up of the child.…”

Section: Discussionmentioning

confidence: 99%

Cardiac tamponade during pregnancy due to primary lung cancer: A case report

Ito

Watanabe

et al. 2022

Obstet Med

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We report a rare case of cardiac tamponade caused by lung cancer in a pregnant woman. A 32-year-old multiparous pregnant woman was admitted to the hospital at 15 weeks of gestation with a persistent cough and dyspnea. Transthoracic echocardiography revealed a pericardial effusion with evidence of tamponade physiology. Computed tomography (CT) revealed a massive pericardial effusion and a left lung tumor. Pericardial tamponade was successfully treated using pericardiocentesis. She was diagnosed with lung adenocarcinoma stage IVB based on bronchoscopic lung biopsy, which showed adenocarcinoma and CT, which showed brain metastasis. Pregnancy was terminated at 18 weeks of gestation, followed by molecular-targeted therapy with alectinib hydrochloride and whole-brain irradiation. 24 months after treatment initiation the patient is alive without disease progression. Although pericardial tamponade caused by a malignant tumor during pregnancy is a rare and serious life-threatening condition, appropriate diagnosis and prompt treatment can improve maternal prognosis.

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Use of tyrosine kinase inhibitors during pregnancy for oncogenic-driven advanced non-small cell lung carcinoma

Cited by 12 publications

References 41 publications

Treating anaplastic lymphoma kinase (ALK) fusion-driven metastatic non-small cell lung cancer (NSCLC) with alectinib through pregnancy

Treating anaplastic lymphoma kinase (ALK) fusion-driven metastatic non-small cell lung cancer (NSCLC) with alectinib through pregnancy

Case report: Osimertinib administration during pregnancy in a woman with advanced EGFR-mutant non-small cell lung cancer

Cardiac tamponade during pregnancy due to primary lung cancer: A case report

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