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.
Department of Gynaecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), France.
Lung Cancer. 2021 Nov;161:68-75. doi: 10.1016/j.lungcan.2021.09.001. Epub 2021 Sep 11.
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.
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.
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.
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.
肺癌合并妊娠较为罕见，但发病率呈上升趋势。针对晚期致癌驱动的非小细胞肺癌（NSCLC），酪氨酸激酶抑制剂（TKI）治疗的应用提高了总体生存率。目前，针对 NSCLC 患者在妊娠期间接受 TKI 治疗的患者的肿瘤学和产科结局评价较差。
从法国妊娠相关癌症网络（Cancer Associé à La Grossesse，CALG）前瞻性数据库中收集了 3 例 NSCLC 患者在妊娠期间接受 TKI 治疗的病例，并通过 2000 年至 2021 年期间的系统回顾确定了另外 8 例病例。
在报告的 11 例患者中，6 例接受了 EGFR-TKI 治疗，5 例接受了 ALK-TKI 治疗。所有患者均为年轻的非吸烟者，4 例在诊断时已有脑转移。3 例患者在妊娠早期开始接受 TKI 治疗。11 例患者中有 10 例发生早产。1 例接受奥希替尼和曲妥珠单抗治疗的患者发生羊水渗漏。5 例新生儿为低体重儿。未观察到新生儿畸形。通过脐带血取样证实了 TKI 的扩散，EGFR-TKI 约占母体浓度的 1/3，ALK-TKI 约占 1/8。在儿童中未观察到发育异常（随访 30 个月）。当报告时，TKI 的抗肿瘤疗效和耐受性似乎与一般人群中描述的相似。
我们的结果支持在妊娠期间使用 TKI 的合理性，这不仅体现在对母体 NSCLC 疾病控制方面，也体现在对胎儿的影响相对较轻方面。我们的数据将有助于更好地向患者告知在妊娠期间使用 TKI 相关的风险，从而有助于做出共同决策。
