Elsevier

Lung Cancer

Volume 77, Issue 2, August 2012, Pages 469-472
Lung Cancer

Case report
Use of erlotinib throughout pregnancy: A case-report of a patient with metastatic lung adenocarcinoma

https://doi.org/10.1016/j.lungcan.2012.03.026Get rights and content

Abstract

The use of erlotinib throughout pregnancy has not been previously reported. We present the case of a 40 year-old female patient with stage IV lung adenocarcinoma, mediastinal, bone and cerebral metastasis, a EGFR mutation and no smoking history, who had begun first line treatment with erlotinib 150 mg once daily. After two and a half months of treatment a fourteen-week pregnancy was documented, and after informing on fetal risks secondary to erlotinib use and maternal risks secondary to treatment withholding, she decided to continue with treatment under clinical surveillance by both the oncology and obstetrics clinics. At thirty-three weeks gestation a live born 1600 g female was born by caesarean section without evidence of congenital malformations. Imaging assessment after eight months of treatment showed complete bone and central nervous system response and partial lung and mediastinal response. The patient is currently undergoing the 11th month of treatment and is asymptomatic, the baby is 4 months old and is in good health.

Introduction

The diagnosis of cancer and pregnancy is an emotional challenge and entails an ethical dilemma for the patient, her family, physicians and society [1]. The incidence of cancer and pregnancy is approximately 1 in 1000 pregnancies [2]. To our knowledge only 44 cases of women with lung cancer during pregnancy have been published, more than 80% corresponding to stages III and IV, with a median survival of 4.5 months. Only 9 achieved survival larger than 1 year and 26% had documented metastasis to the products of conception [1], [3]. There is only one report on the use of erlotinib during the first 8 weeks of gestation [4].

We report on the first case of a patient with stage IV lung adenocarcinoma in whom a fourteen-week pregnancy had been documented under erlotinib treatment. The patient has achieved partial response, and the baby is in good health.

Section snippets

Case description

A forty year-old female with no smoking history presented with two months of dry cough and moderate exertion dyspnea which was followed by chest pain. A chest X-ray revealed a left lower lobe infiltrate interpreted as pneumonia and treated with clarithromycin with no improvement. Given the persistence of symptoms a computed tomography was obtained and a transbronchial biopsy performed which confirmed the diagnosis of non-mucinous bronchioloalveolar carcinoma with multiple pulmonary and

Discussion

Lung cancer is the fourth most frequent cause of cancer and the second cause of cancer death in women worldwide [5]. Patients with stage IV lung adenocarcinoma have a poor prognosis with a median survival of 5 months and a global survival of 23.3% at 1 year and 9.9% at 2 years [6].

To our knowledge only 44 cases of women with lung cancer during pregnancy have been published, 90% corresponding to advanced illness and thus were not candidates for surgical treatment. Most patients had a bad postpartum

Conflict of interest statement

The authors declare no conflicts of interest.

Acknowledgements

We would like to thank Dr. Oswaldo Sánchez member of the Clinical Oncology Group at Cancerology National Institute and Dr. Alfonso Lozano member of the Radiology Group at Cancerology National Institute, Bogota, Colombia.

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