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Simons E, Camidge DR. Lung Cancer Oncogene-Directed Therapy, Fertility, and Pregnancy. J Thorac Oncol 2024; 19:866-876. [PMID: 38185202 DOI: 10.1016/j.jtho.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Alterations in the highly actionable lung cancer oncogenes, EGFR, ALK, and ROS1, occur across the age spectrum. Pregnancy and plans for motherhood consequently overlap with diagnoses of advanced oncogene-driven NSCLC. Guidelines for cytotoxic agents and pregnancy are well established. Nevertheless, accessible data on targeted lung cancer therapy during pregnancy or egg retrieval has not been collated previously, nor have the issues of reproduction in the setting of specific oncogene-addicted advanced NSCLC been widely discussed. METHODS We performed a narrative review of ex vivo placenta perfusion studies, pharmacologic characteristics, mutagenicity, animal embryo-fetal development studies, and case reports of pathways to motherhood, pregnancies, and egg retrieval while on EGFR-, ALK-, or ROS1-targeted therapy. RESULTS EGFR inhibitors may reduce female fertility while on therapy owing to decrease in corpora lutea. Odds of pregnancy in women on EGFR and ALK inhibitors may be reduced owing to potential increase in postimplantation loss found in animals. Crizotinib and entrectinib exhibit in vitro mutagenic potential. Several effects on human pregnancies have been noted; however, 11 EGFR and ALK tyrosine kinase inhibitor-exposed infants have been documented free of substantial adverse health effects by ages 4 months to 2 years. Successful gestational surrogacy has been reported in two women treated with crizotinib. Adoption and termination approaches have also been undertaken by some patients. CONCLUSIONS Reproduction may not be out of reach for some patients with advanced NSCLC. Additional explorations of the impact and optimal timing of targeted therapy in egg capture and pregnancy are needed. Wider scientific and societal discussion about the issues of reproduction in advanced NSCLC is warranted.
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Affiliation(s)
- Emily Simons
- University of Colorado Cancer Center, Aurora, Colorado; Banner MD Anderson Cancer Center, Loveland, Colorado.
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Gonzalez-Mosquera LF, Rous FA, Rogers A, Smith N, Goyert G, Gadgeel S. ALK Rearrangement Positive Lung Adenocarcinoma in Pregnancy Treated With Alectinib: A Case Report. Clin Lung Cancer 2024; 25:e77-e80. [PMID: 38057186 DOI: 10.1016/j.cllc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Abstract
There are few reported cases of ALK gene rearranged (ALK+) non-small cell lung cancer (NSCLC) during pregnancy. There is a lack of information on the safety of ALK inhibitors in pregnant patients. We present a 25-year-old African American woman who was diagnosed with metastatic ALK+ lung adenocarcinoma at 15 weeks of gestation. Treatment with alectinib was initiated at 18 weeks' gestation with resultant radiological treatment response. The patient did not experience any adverse effects from alectinib during her pregnancy. An elective induction of labor at 39 weeks resulted in an uncomplicated vaginal delivery. This case adds to available data and provides insight on the safety of using alectinib in a pregnant, ALK+ NSCLC patient, allowing the patient to continue her pregnancy to term while treating advanced lung adenocarcinoma.
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Affiliation(s)
- Luis F Gonzalez-Mosquera
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI
| | - Fawzi Abu Rous
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI
| | | | - Nicolina Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI
| | - Gregory Goyert
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI
| | - Shirish Gadgeel
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute/Henry Ford Health, Detroit, MI.
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Nemoto Y, Kuroda K, Oyama R, Mori M, Shimajiri S, Tanaka F. Case report: Pathological complete response of pregnancy associated pulmonary enteric adenocarcinoma to chemoradiotherapy. Front Oncol 2024; 14:1290757. [PMID: 38463225 PMCID: PMC10924307 DOI: 10.3389/fonc.2024.1290757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Pulmonary enteric adenocarcinoma (PEAC) is a rare lung adenocarcinoma with morphological features similar to those of primary and metastatic colorectal adenocarcinoma. To date, only a few studies have reported the therapeutic effects of chemoradiotherapy on PEAC. This report describes the case of a 28-year-old woman with pregnancy-related PEAC who presented with left shoulder pain. A superior sulcus tumor was identified in the left thoracic cavity, and the biopsy indicated more than 50% intestinal differentiation components. Moreover, immunohistochemical staining revealed positive CDX2 and CK7 expression. Positron emission tomography-computed tomography, upper endoscopy, colonoscopy, and small intestinal capsule endoscopy revealed no gastrointestinal malignancies. The patient was diagnosed with locally advanced PEAC (clinical stage T4N0M0; stage IIIA). Therefore, the patient was treated with preoperative chemoradiotherapy and underwent gross total resection during surgery. Pathological evaluation of the specimen revealed no residual tumor, indicating that the chemoradiotherapy for PEAC was highly effective. One subsequent brain metastasis was also resected, and the patient has not experienced recurrence in 28 months since this resection and continues to be monitored regularly. This is the first pathologically confirmed report of the use of chemoradiotherapy (carboplatin [CBDCA] and paclitaxel [PTX]) for PEAC and its clinical efficacy. Unlike previous reports, the efficacy of this treatment is attributed to the use of PTX in preoperative chemotherapy and the p21- status of the patient, which may have increased sensitivity to chemoradiation therapy. Therefore, chemoradiotherapy (CBDCA + PTX) may be a viable treatment option for advanced intestinal lung adenocarcinoma.
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Affiliation(s)
- Yukiko Nemoto
- Second Department of Surgery (Chest Surgery), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Koji Kuroda
- Second Department of Surgery (Chest Surgery), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Rintaro Oyama
- Second Department of Surgery (Chest Surgery), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Masataka Mori
- Second Department of Surgery (Chest Surgery), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Shohei Shimajiri
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery (Chest Surgery), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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Ma Q, Shu P, Zhou K, Wang Y. Case Report: Termination of unplanned pregnancy led to rapid deterioration of non-small-cell lung cancer during osimertinib treatment. Front Oncol 2023; 13:1073938. [PMID: 37916176 PMCID: PMC10616458 DOI: 10.3389/fonc.2023.1073938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/20/2023] [Indexed: 11/03/2023] Open
Abstract
We present a case of a woman with non-small-cell lung cancer (NSCLC) who experienced disease progression during treatment with the epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) osimertinib due to an unplanned pregnancy. Given the risk of tumor progression, the patient underwent an artificial abortion. However, disease deterioration occurred shortly after termination of the pregnancy, with severe chest pain, increased dyspnea, and pleural effusion. After positive rescue measures, including emergency thoracic drainage, thoracentesis, and oxygen uptake, her symptoms improved. Considering pregnancy as an immune escape physiological process, the patient continued treatment with osimertinib, and a partial response (PR) lasting 16 months was observed. Therefore, this case highlights the importance of being vigilant about the rapid development of the tumor after delivery in pregnant patients with EGFR-mutation lung cancer and taking preventive measures to cope with various emergencies.
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Affiliation(s)
- Qizhi Ma
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Pei Shu
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Kexun Zhou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yongsheng Wang
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Gogineni V, Gingell L, Varghese M, Hrinczenko B. Placental and Breast Metastasis of Squamous Cell Carcinoma in a Patient With Recurrent Respiratory Papillomatosis. Cureus 2023; 15:e46183. [PMID: 37905287 PMCID: PMC10613337 DOI: 10.7759/cureus.46183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP), which is usually benign, is an intractable disease characterized by recurrent papillomas (wart-like lesions). Although it most commonly involves the mucosal epithelial lining of the upper respiratory tract, on rare occasions, it can also involve lung parenchyma. RRP carries the risk of malignant transformation, most often to non-small-cell squamous lung cancer. Here, we present the case of a 32-year-old pregnant female with a past medical history of RRP who developed mild respiratory distress during her immediate postpartum period. This prompted imaging of the chest which revealed right lower lobe hypodensities with extensive hilar and perihilar lymphadenopathy. Histopathology of the bronchial specimen showed squamous cell carcinoma with 100% programmed death-ligand 1 (PD-L1) expression. Gross examination of the patient's placenta showed multiple tan-colored nodules which was confirmed on histopathological examination as multifocal regions of squamous cell carcinoma metastatic from the lung. The patient underwent a staging positron emission tomography (PET) scan which showed hypermetabolic regions in the right middle and lower lobes of the lung, with avidity in the right paratracheal region and an enhancing lesion in the left breast. Biopsy from the breast lesion was also positive for squamous cell carcinoma and PD-L1. She was diagnosed with Stage IVB (T1c, N3, M1c) non-small-cell squamous lung cancer and was started on pembrolizumab. Carboplatin and paclitaxel were added after an initial mixed response to therapy. The patient was non-compliant with her updated treatment regimen as well as with outpatient follow-up visits. A restaging PET scan demonstrated an inadequate response to the amended immunotherapy/chemotherapy regimen. Ultimately, she passed away within one and a half years of her initial diagnosis. Malignant transformation of papillomatous lesions into squamous cell cancer is infrequent, and the occurrence of metastasis to the breast and/or placenta is exceptionally rare. To our knowledge, this is the first reported case of placental and breast metastasis of squamous cell lung cancer in a patient with RRP.
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Affiliation(s)
- Venumadhavi Gogineni
- Internal Medicine, Michigan State University, East Lansing, USA
- Internal Medicine, Michigan State University- Sparrow Hospital, Lansing, USA
| | - Luke Gingell
- Oncology, Michigan State University College of Human Medicine, East Lansing, USA
| | - Merryl Varghese
- Internal Medicine, Michigan State University, East Lansing, USA
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Simons EA, Patil T, Camidge DR. Pregnancy and Pathways to Motherhood in Oncogene-driven Lung Cancer: A Single Institution Experience. Clin Lung Cancer 2023; 24:e55-e59. [PMID: 36470760 DOI: 10.1016/j.cllc.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Emily A Simons
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, CO
| | - Tejas Patil
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, CO
| | - D Ross Camidge
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, CO.
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Placental Metastatic Lung Cancer: A Case Report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2023. [DOI: 10.1016/j.cpccr.2023.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Zhuang W, Qiao G. Pregnancy-associated lung cancer: a clinical and scientific challenge more than treatment dilemma. J Thorac Dis 2021; 13:5572-5574. [PMID: 34659822 PMCID: PMC8482339 DOI: 10.21037/jtd-21-1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Weitao Zhuang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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