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

Gil, Sophie; Goetgheluck, J.; Paci, Angélo; Broutin, Sophie; Friard, S.; Couderc, Louis‐Jean; Ayoubi, Jean Marc; Picone, Olivier; Tchérakian, Colas

doi:10.1016/j.lungcan.2014.06.003

Cited by 30 publications

(21 citation statements)

References 14 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: 51%

“…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%

“…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. 22 To our knowledge, there are no published reports of treatment with ALK inhibitors during pregnancy.…”

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: 51%

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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“…What's more, when considering the clinical benifits of Gefitinib, the assessment with evidence of the efficacy and toxicity of the treatment of NSCLC is one of the most capital factors restraining its application in the course of treatment [32]. Till now, many reports focus on both efficacy and toxicity of the current state of Gefitinib therapy in NSCLC patients, and some typical adverse effects have been revealed [33, 34]. Unanswered questions about the optimal use of Gefitinib still remain open.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of non-small cell lung cancer (NSCLC) growth by a novel small molecular inhibitor of EGFR

Deng

et al. 2015

Oncotarget

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The epidermal growth factor receptor (EGFR) is a therapeutic target (oncotarget) in NSCLC. Using in vitro EGFR kinase activity system, we identified a novel small molecule, WB-308, as an inhibitor of EGFR. WB-308 decreased NSCLC cell proliferation and colony formation, by causing G2/M arrest and apoptosis. Furthermore, WB-308 inhibited the engraft tumor growths in two animal models in vivo (lung orthotopic transplantation model and patient-derived engraft mouse model). WB-308 impaired the phosphorylation of EGFR, AKT, and ERK1/2 protein. WB-308 was less cytotoxic than Gefitinib. Our study suggests that WB-308 is a novel EGFR-TKI and may be considered to substitute for Gefitinib in clinical therapy for NSCLC.

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“…Recently, the first case of an EGFR mutationpositive NSCLC in a 33-year-old female at 26 weeks of gestation has been reported. 16 This patient was treated with gefitinib, 250 mg/d, as first-line therapy during pregnancy. Therapy led to rapid symptom improvement that allowed a planned cesarean section in week 35.…”

mentioning

confidence: 99%

Lung Cancer in Pregnancy—A Forgotten Disease Entity

Rothschild

2016

Journal of Thoracic Oncology

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

Cited by 30 publications

References 14 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

Inhibition of non-small cell lung cancer (NSCLC) growth by a novel small molecular inhibitor of EGFR

Lung Cancer in Pregnancy—A Forgotten Disease Entity

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