Kato Mari, Yamaura Takumi, Mine Hayato, Kin Shogo, Suzuki Hiroyuki
Obstetrics and Gynecology, Takeda General Hospital, Fukushima, JPN.
Thoracic Surgery, Takeda General Hospital, Fukushima, JPN.
Cureus. 2024 Jul 1;16(7):e63592. doi: 10.7759/cureus.63592. eCollection 2024 Jul.
Non-small cell lung cancer (NSCLC) occasionally develops in younger, fertile patients. This early-onset NSCLC tends to have more oncogenic driver mutations than in aged patients. Among early-onset NSCLC patients, pregnancy is very rare. However, there are some patients who were able to balance tyrosine kinase inhibitor (TKI) administration and pregnancy. Here, we report a case of a pregnancy under alectinib hydrochloride (a second-generation anaplastic lymphoma kinase (ALK)-TKI) administration throughout the entire gestational period for ALKrearranged metastatic lung adenocarcinoma. The patient was an Asian female in her early 20s who became aware of her pregnancy after diagnosis and the start of alectinib administration. She intended to have the baby despite the necessity of continuing her treatment and the unknown risks involved. A multidisciplinary team (thoracic surgeon, obstetrics, pediatrics, and so on) was organized to support the patient, baby, and family. There were no obvious signs of tumor progression during pregnancy. She gave birth at 41 weeks and one day of gestation. There was no placental metastasis. Alectinib concentration at delivery was 155 ng/mL in maternal blood, 22.1 ng/mL in umbilical cord venous blood, 20.1 ng/mL in amniotic fluid, and 11.8 ng/mL in colostrum. The baby had been exposed to alectinib throughout the entire pregnancy; however, fetal growth curve parameters remained within the normal ranges and the baby developed without anatomical or neurodevelopmental anomalies or fetal metastasis for the first 13 months of age.
非小细胞肺癌（NSCLC）偶尔会在年轻的育龄患者中发生。这种早发型NSCLC往往比老年患者有更多的致癌驱动基因突变。在早发型NSCLC患者中，怀孕的情况非常罕见。然而，有一些患者能够在酪氨酸激酶抑制剂（TKI）治疗与怀孕之间取得平衡。在此，我们报告一例ALK重排转移性肺腺癌患者在整个妊娠期接受盐酸阿来替尼（第二代间变性淋巴瘤激酶（ALK）-TKI）治疗期间怀孕的病例。患者是一名20岁出头的亚洲女性，在诊断并开始使用阿来替尼后发现自己怀孕。尽管需要继续治疗且存在未知风险，但她仍打算生下这个孩子。于是组建了一个多学科团队（胸外科医生、产科医生、儿科医生等）来支持患者、婴儿和家庭。孕期未出现明显的肿瘤进展迹象。她在妊娠41周零1天时分娩。未发现胎盘转移。分娩时母体血液中阿来替尼浓度为155 ng/mL，脐静脉血中为22.1 ng/mL，羊水中为20.1 ng/mL，初乳中为11.8 ng/mL。婴儿在整个孕期都接触到了阿来替尼；然而，胎儿生长曲线参数仍在正常范围内，并且在13个月大之前，婴儿发育正常，未出现解剖学或神经发育异常或胎儿转移的情况。
