Successful Treatment of Non–Small Cell Lung Cancer With Erlotinib Throughout Pregnancy

Abstract

Erlotinib is the standard of care for epidermal growth factor receptor (EGFR) mutated lung adenocarcinomas in the United States. However, in pregnant patients with lung cancer, chemotherapy is recommended, irrespective of EGFR mutations, given the lack of experience and uncertainty for fetus's safety with erlotinib.

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

“…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.…”

“…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.…”

“…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.…”

“…In contrast, the clinical outcomes of pregnant EGFR– mutant and ALK -positive NSCLC patients previously reported in the literature were comparable to those reported for non-pregnant patients. 15, 17, 19, 20 It is possible that the shorter PFS in this series may be confounded by additional factors, including diagnostic delays in two cases (case 6 and 8). Alternatively, a pregnancy/peripartum diagnosis of NSCLC may predispose to a particularly aggressive clinical course.…”

Lung Cancer in Pregnancy—A Forgotten Disease Entity

“…Recently, several other case reports have been published and show feasibility of the use of EGFR tyrosine kinase inhibitors (TKIs). [16][17][18][19] So far, no data for the use of anaplastic lymphoma kinase TKIs during pregnancy exist.…”