We report the history, treatment and outcome of a patient with stage IV non-small-cell lung cancer (NSCLC) diagnosed in the second trimester of pregnancy.
A 22 year-old female non-smoker, at 21 weeks of pregnancy, was diagnosed with stage IV bronchoalveolar cell carcinoma (BAC) after 2 months of nonspecific respiratory symptoms and persistent radiographic abnormalities. The patient’s respiratory condition required prolonged intubation and mechanical ventilation in the Intensive Care Unit. One week after diagnosis, treatment with the epidermal growth factor receptor (EGFR) inhibitor, Geftinib, was initiated. At 26 weeks of pregnancy she underwent emergent cesarean-section for pre-term, premature rupture of membranes. One week later, she improved and was discharged home to complete a total of 6 weeks of Geftinib. Ten days after discharge she suffered cardiorespiratory arrest. She expired 2 days after readmission.After birth, the infant spent 79 days in the neonatal intensive care unit. At 16-month follow-up he did not demonstrate obvious EGFR-inhibitor related side effects.
In this case, the patient’s age, pregnancy, fetal health and critical illness posed a major challenge to instituting chemotherapy. Geftinib was used primarily to prolong maternal survival to at least 24 weeks of pregnancy, after which point elective cesarean-section was planned. Geftinib has been reported to provide a quick response in female nonsmokers with BAC. The infant is currently doing well despite in utero exposure to Geftinib, maternal critical illness and preterm status.
To our knowledge, this is the first case reported in the medical literature of a pregnant woman receiving an EGFR inhibitor therapy for advanced NSCLC. Despite being uncommon, the diagnosis of BAC should be considered in young women with persistent respiratory symptoms and radiographic abnormalities. Diagnostic procedures should not be delayed, even in pregnancy. In this case using an EGFR inhibitor did not cause fetal harm.
Oscar Parodi, No Financial Disclosure Information; No Product/Research Disclosure Information