YO28 - TKI for Metastatic Non Small Cell Lung Cancer in Pregnancy.

Case summary

Introduction

In metastatic non small cell lung carcinoma (NSCLC), tyrosine kinase inhibitor(TKIs) is first line treatment based on the molecular profiling. However, due to the ethical issues, there is no prospective studies to show the safety of TKIs in pregnancy. Therefore, the decision making is based on the scarce case reports.

Here we would like to share a case report of a patient who was diagnosed with Exon 19 deletion metastatic lung adenocarcinoma at 25 weeks of pregnancy.

Case 1

Mrs AN was a 29 years old lady, G1P0 who was diagnosed with metastatic Exon 19 deletion NSCLC, at gestational age of 25 weeks after presented with malignant pleural effusion requiring ICU admission for ventilatory support.

CT Thorax showed heterogeneously enhancing mass like consolidation measuring 7x4x4.9cm at peribronchovascular region of anterior segment of right upper lobe with moderate hydropneumothorax.

After comprehensive consultaion with regards to safety of TKI during pregnancy, she was started on Gefitinib 250mg OD with close monitoring from oncology and antenatal team.

Throughout the T gefitinib course, her fetal growth and wellbeing was up to the gestational age without concerns. Hence she was able to achieve full term delivery at 39 weeks via LSCS. She gave birth to a healthy baby girl. There were no congenital abnormalities reported. She tolerated T gefitinib very well with G1 diarrhea and acneiform rashes intermittently but resolved spontaneously not requiring medications.

Her reassessment CT thorax, abdomen pelvis (7 months after starting on T gefitinib) showed that lobulated and enhancing right pleural thickening was no longer seen. No new lung nodule. Smaller mediastinal nodes. The hydropneumothorax has resolved.

Discussion

This case report showed T gefitinib is safe during her pregnancy as she was able to achieve full term delivery with no complications to the baby observed. Besides that, this case also showed that she had good control of the disease with Gefitinib as she no longer required oxygen support.

Conclusion

Malignancy in pregnancy is an area of uncertainties in oncological treatment due to limited data and ethical issues. Comprehensive consultation is mandatory so that the patient would be to make informed decision and understand the risks.

Clinical trial identification

Editorial acknowledgement