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Simons E, Camidge DR. Lung Cancer Oncogene-Directed Therapy, Fertility, and Pregnancy. J Thorac Oncol 2024; 19:866-876. [PMID: 38185202 DOI: 10.1016/j.jtho.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Alterations in the highly actionable lung cancer oncogenes, EGFR, ALK, and ROS1, occur across the age spectrum. Pregnancy and plans for motherhood consequently overlap with diagnoses of advanced oncogene-driven NSCLC. Guidelines for cytotoxic agents and pregnancy are well established. Nevertheless, accessible data on targeted lung cancer therapy during pregnancy or egg retrieval has not been collated previously, nor have the issues of reproduction in the setting of specific oncogene-addicted advanced NSCLC been widely discussed. METHODS We performed a narrative review of ex vivo placenta perfusion studies, pharmacologic characteristics, mutagenicity, animal embryo-fetal development studies, and case reports of pathways to motherhood, pregnancies, and egg retrieval while on EGFR-, ALK-, or ROS1-targeted therapy. RESULTS EGFR inhibitors may reduce female fertility while on therapy owing to decrease in corpora lutea. Odds of pregnancy in women on EGFR and ALK inhibitors may be reduced owing to potential increase in postimplantation loss found in animals. Crizotinib and entrectinib exhibit in vitro mutagenic potential. Several effects on human pregnancies have been noted; however, 11 EGFR and ALK tyrosine kinase inhibitor-exposed infants have been documented free of substantial adverse health effects by ages 4 months to 2 years. Successful gestational surrogacy has been reported in two women treated with crizotinib. Adoption and termination approaches have also been undertaken by some patients. CONCLUSIONS Reproduction may not be out of reach for some patients with advanced NSCLC. Additional explorations of the impact and optimal timing of targeted therapy in egg capture and pregnancy are needed. Wider scientific and societal discussion about the issues of reproduction in advanced NSCLC is warranted.
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Affiliation(s)
- Emily Simons
- University of Colorado Cancer Center, Aurora, Colorado; Banner MD Anderson Cancer Center, Loveland, Colorado.
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Wu F, Rittberg R, Lim K, Ho C. Treating anaplastic lymphoma kinase (ALK) fusion-driven metastatic non-small cell lung cancer (NSCLC) with alectinib through pregnancy. BMJ Case Rep 2024; 17:e255575. [PMID: 38531551 PMCID: PMC10966728 DOI: 10.1136/bcr-2023-255575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
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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Affiliation(s)
- Florence Wu
- Medical Oncology, BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Rebekah Rittberg
- Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Kenneth Lim
- Maternal Fetal Medicine, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Cheryl Ho
- Medical Oncology, BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
- Medical Oncology, The University of British Columbia, Vancouver, British Columbia, Canada
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Gonzalez-Mosquera LF, Rous FA, Rogers A, Smith N, Goyert G, Gadgeel S. ALK Rearrangement Positive Lung Adenocarcinoma in Pregnancy Treated With Alectinib: A Case Report. Clin Lung Cancer 2024; 25:e77-e80. [PMID: 38057186 DOI: 10.1016/j.cllc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Abstract
There are few reported cases of ALK gene rearranged (ALK+) non-small cell lung cancer (NSCLC) during pregnancy. There is a lack of information on the safety of ALK inhibitors in pregnant patients. We present a 25-year-old African American woman who was diagnosed with metastatic ALK+ lung adenocarcinoma at 15 weeks of gestation. Treatment with alectinib was initiated at 18 weeks' gestation with resultant radiological treatment response. The patient did not experience any adverse effects from alectinib during her pregnancy. An elective induction of labor at 39 weeks resulted in an uncomplicated vaginal delivery. This case adds to available data and provides insight on the safety of using alectinib in a pregnant, ALK+ NSCLC patient, allowing the patient to continue her pregnancy to term while treating advanced lung adenocarcinoma.
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Affiliation(s)
- Luis F Gonzalez-Mosquera
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI
| | - Fawzi Abu Rous
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI
| | | | - Nicolina Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI
| | - Gregory Goyert
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI
| | - Shirish Gadgeel
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI.
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Zhou JP, Wang Y, Lin YN, Sun XW, Ding YJ, Yan YR, Li N, Zhang L, Li QY. Clinical Features and Management of Lung Cancer During Pregnancy: A Narrative Review Based on Reported Cases. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:544-550. [PMID: 38023372 PMCID: PMC10664570 DOI: 10.1089/whr.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023]
Abstract
This review aims to provide a summary of the clinical characteristics and outcomes of lung cancer during pregnancy. A comprehensive literature search yielded 93 cases of lung cancer during pregnancy from 1953 to 2022, with an average maternal age of ∼34 years old. The initial symptoms reported were often nonspecific, such as cough, dyspnea, and chest pain. Cancer-related treatments, including surgery, radiotherapy, chemotherapy, and tyrosine kinase inhibitors, have shown beneficial effects on maternal outcomes. A majority of the newborns were born without malformation or diseases, but extended follow-up remains necessary. Early diagnosis of lung cancer is imperative for reducing the risks of placental and fetal metastasis and enhancing overall survival.
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Affiliation(s)
- Jian Ping Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Wang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Ni Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xian Wen Sun
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Jie Ding
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya Ru Yan
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Predicting fetal exposure of crizotinib during pregnancy: Combining human ex vivo placenta perfusion data with physiologically-based pharmacokinetic modeling. Toxicol In Vitro 2022; 85:105471. [PMID: 36096459 DOI: 10.1016/j.tiv.2022.105471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/22/2022]
Abstract
Commercially available physiologically-based pharmacokinetic (PBPK) modeling platforms increasingly allow estimations of fetal exposure to xenobiotics. We aimed to explore a physiology-based approach in which literature data from ex vivo placenta perfusion studies are used to parameterize Simcyp's pregnancy-PBPK (p-PBPK) model, taking crizotinib as an example. First, a physiologically-based semi-mechanistic placenta (PBMP) model was developed in MATLAB to analyze placenta perfusion data of crizotinib. Mixed-effects modeling was performed to derive intrinsic unbound clearance values across the maternal-placental barrier and fetal-placental barrier. Values were then used for parameterization of the p-PBPK model. The PBMP model adequately described the perfusion data. Clearance was estimated to be 71 mL/min and 535 mL/min for the maternal placental uptake and efflux, and 8 mL/min and 163 mL/min for fetal placental uptake and efflux, respectively. For oral dosing of 250 mg twice daily, p-PBPK modeling predicted a Cmax and AUC0-τ of 0.08 mg/L and 0.78 mg/L*h in the umbilical vein at steady-state, respectively. In placental tissue, a Cmax of 5.04 mg/L was predicted. In conclusion, PBMP model-based data analysis and the associated p-PBPK modeling approach illustrate how ex vivo placenta perfusion data may be used for fetal exposure predictions.
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Weidenbaum C, Cann CG, Osmundson S, Iams WT, Osterman T. Two Uncomplicated Pregnancies on Alectinib in a Woman With Metastatic ALK-Rearranged NSCLC: A Case Report. JTO Clin Res Rep 2022; 3:100361. [PMID: 35814861 PMCID: PMC9264015 DOI: 10.1016/j.jtocrr.2022.100361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Lung cancer incidence is increasing in pregnancy due in part to advanced maternal age. A subset of patients with NSCLC during pregnancy harbor an ALK gene rearrangement. Although ALK inhibitors, such as alectinib, are routinely used to treat ALK-rearranged NSCLC, there are limited safety data regarding use during pregnancy and fetal effects. Here, we report the second case of a patient with metastatic ALK-rearranged lung adenocarcinoma treated with alectinib throughout pregnancy. Notably, the patient had two uncomplicated pregnancies with routine obstetrical and postnatal courses. In this case, alectinib did not seem to affect embryofetal or early childhood development. This does not exclude undetectable or delayed toxic effects, and additional studies are needed to further reveal the safety of alectinib treatment during pregnancy.
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Fu Z, Zhu G, Wang L, Hu S, Cheng L, Liu F. Case Report: A Pregnant Woman Diagnosed as ALK-Rearrangement Lung Large Cell Neuroendocrine Cancer With Brain Metastasis. Front Oncol 2022; 12:823813. [PMID: 35280726 PMCID: PMC8916559 DOI: 10.3389/fonc.2022.823813] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
Concomitant malignant tumors and pregnancy present many difficult questions to both clinicians and patients. Due to no specific guidelines, each aspect of clinical management requires special considerations. This current report presents a rare case of a 38-year-old pregnant woman at gestational age 33 weeks with complaints of weakness of her right limbs for 2 weeks. After successive cesarean section and craniotomy, a diagnosis of lung large cell neuroendocrine carcinoma (LCNEC) metastatic to the brain was eventually made. Next generation sequencing (NGS) showed ALK-EML4 gene fusion. Immediately afterwards she was started on the targeted therapy with the ALK inhibitor alectinib. Ten months later, all known lesions exhibited a rapid regression, and no new brain metastases were found. Consequently, the therapeutic effect was considered as a partial response. Then, we review the previous literature using PubMed on maternal malignant brain tumors diagnosed during pregnancy, or lung LCNEC associated with ALK fusion, or ALK inhibitors treatment among the pregnant women, eventually, and discuss the concerns of dealing with these patients.
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Affiliation(s)
- Zaixiang Fu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ganggui Zhu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liquan Wang
- Department of Obstetrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shen Hu
- Department of Obstetrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Cheng
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fuyi Liu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Fuyi Liu,
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Boudy AS, Grausz N, Selleret L, Gligorov J, Thomassin-Naggara I, Touboul C, Daraï E, Cadranel J. Use of tyrosine kinase inhibitors during pregnancy for oncogenic-driven advanced non-small cell lung carcinoma. Lung Cancer 2021; 161:68-75. [PMID: 34543940 DOI: 10.1016/j.lungcan.2021.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Lung cancer associated with pregnancy is rare but on the increase. The use of tyrosine kinase inhibitor (TKI) therapy for advanced oncogenic-driven non-small cell lung carcinoma (NSCLC) has improved overall survival. Oncological and obstetric outcomes of patients diagnosed with NSCLC and treated by TKIs during pregnancy have been poorly evaluated. METHODS Three cases of NSCLC treated by TKIs during pregnancy were collected from the prospective database of the Cancer Associé à La Grossesse (CALG) network (France) in addition to eight cases identified by a systematic review performed between 2000 and 2021. RESULTS Among the eleven reported patients, six received an EGFR- and five an ALK-TKI. All patients were young nonsmokers and four had brain metastases at diagnosis. TKI treatment was initiated during the first trimester for three patients. Premature delivery was induced in 10/11 patients. Anamnios occurred in one patient treated by osimertinib and trastuzumab. Five newborns were hypotrophic. No newborn malformations were observed. Diffusion of the TKIs, confirmed by blood cord sampling, represented about 1/3 (EGFR-TKI) and 1/8 (ALK-TKI) of the maternal concentration. No developmental abnormalities were observed in the children (follow-up 30 months). The anti-tumor efficacy and tolerance of TKIs, when reported, appears similar to that described in the general population. CONCLUSIONS Our results support the rationale for using TKIs during pregnancy, both in terms of maternal NSCLC disease control and the relatively mild effects on the fetus. Our data will serve to better inform patients about the risks associated with TKIs used during pregnancy, contributing to shared decision making.
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Affiliation(s)
- Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France.
| | - Noémie Grausz
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France
| | - Joseph Gligorov
- Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Isabelle Thomassin-Naggara
- Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France; Department of Radiology, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Cancer Associé à La Grossesse (CALG), French National CALG Network, Sorbonne University, France; APHP Tenon, INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Jacques Cadranel
- Department of Pulmonology and Thoracic Oncology, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Tenon and GRC 04 Theranoscan, Sorbonne Université, Paris 75970, France.
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9
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Yang L, He YT, Kang J, Zheng MY, Chen ZH, Yan HH, Zhang XC, Yang JJ, Wu YL, Zhou Q. Clinical features and intervention timing in patients with pregnancy-associated non-small-cell lung cancer. J Thorac Dis 2021; 13:4125-4136. [PMID: 34422342 PMCID: PMC8339795 DOI: 10.21037/jtd-21-234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/27/2021] [Indexed: 12/18/2022]
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.
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Affiliation(s)
- Lei Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yun-Ting He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Kang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming-Ying Zheng
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi-Hong Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xu-Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin-Ji Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Scarfone G, Fumagalli M, Imbimbo M, Ceruti T, Cribiù FM, Di Loreto E, D'Incalci M, Facchin F, Fontana C, Garassino MC, Peccatori FA, Persico N, Signorelli D, Zucchetti M. First Case Report of Pregnancy on Alectinib in a Woman With Metastatic ALK-Rearranged Lung Cancer: A Case Report. J Thorac Oncol 2021; 16:873-877. [PMID: 33795207 DOI: 10.1016/j.jtho.2021.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/25/2023]
Abstract
This is the first case report of a patient with ALK-rearranged metastatic lung adenocarcinoma who became pregnant during treatment with alectinib. A multidisciplinary team of gynecologists, neonatologists, oncologists, psychologists, and pharmacologists was set up to handle the case. According to patient's preference, the study drug was continued throughout pregnancy and the woman delivered a healthy baby girl at 35 weeks and 5 days of gestation. Fetal parameters remained normal during pregnancy. At birth, alectinib levels were 14 times higher in maternal plasma than in the fetus (259 versus 18 ng/mL). The average concentration of alectinib in the placenta was 562 ng/g. The baby was followed during her first 20 months, and no developmental anomalies were observed. After 32 months from diagnosis, the mother is well and in partial remission.
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Affiliation(s)
- Giovanna Scarfone
- Division of Gynecology and Obstetrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Martina Imbimbo
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - Tommaso Ceruti
- Department of Oncology, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Fulvia Milena Cribiù
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eugenia Di Loreto
- Division of Gynecology and Obstetrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio D'Incalci
- Department of Oncology, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of Milan, Lombardia, Italy
| | - Camilla Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Marina C Garassino
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy; Department of Medicine, Section Hematology Oncology, The University of Chicago, Chicago, Illinois.
| | - Fedro A Peccatori
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Nicola Persico
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Diego Signorelli
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy; Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Massimo Zucchetti
- Department of Oncology, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
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Benoit L, Mir O, Vialard F, Berveiller P. Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents. Cancers (Basel) 2021; 13:1238. [PMID: 33799824 PMCID: PMC8000411 DOI: 10.3390/cancers13061238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
The occurrence of cancer during pregnancy is observed in 1 in 1000 pregnancies and is expected to increase given the trend of delaying childbearing. While breast cancer is the most common, the incidence of other cancers, such as cervical, ovarian, and lung cancers as well as hemopathies and melanomas, is also increasing. Thus, cancer occurrence in pregnant women raises questions of management during pregnancy and, especially, assessment of the treatment benefit-risk ratio to ensure optimal management for the mother while ensuring the safety of the fetus. Chemotherapy remains a cornerstone of cancer management. If the use of anticancer agents appears possible during pregnancy, while avoiding the first trimester, the extent of placental transfer of different anticancer agents varies considerably thereafter. Furthermore, the significant physiological pharmacokinetic variations observed in pregnant women may have an impact on the placental transfer of anticancer agents. Given the complexity of predicting placental transfer of anticancer agents, preclinical studies are therefore mandatory. The aim of this review was to provide updated data on in vivo and ex vivo transplacental transfer of anticancer agents used in the management of the most common pregnancy-associated cancers to better manage these highly complex cases.
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Affiliation(s)
- Laure Benoit
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Gynecology and Obstetrics, 78300 Poissy, France;
| | - Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, 94800 Villejuif, France;
| | - François Vialard
- Université Paris-Saclay, UMR 1198, INRAE, BREED, RHuMA, 78350 Jouy-en-Josas, France;
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Genetics, 78300 Poissy, France
| | - Paul Berveiller
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Gynecology and Obstetrics, 78300 Poissy, France;
- Université Paris-Saclay, UMR 1198, INRAE, BREED, RHuMA, 78350 Jouy-en-Josas, France;
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
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