Treating anaplastic lymphoma kinase (ALK) fusion-driven metastatic non-small cell lung cancer (NSCLC) with alectinib through pregnancy

BMJ Case Rep. 2024 Mar 25;17(3):e255575. doi: 10.1136/bcr-2023-255575.

Abstract

Management of cancer during pregnancy requires careful consideration of risks and benefits from maternal and fetal perspectives. For advanced lung adenocarcinomas, with no targetable driver mutations, there is evidence-based guidance on the use of carboplatin-paclitaxel chemotherapy after first trimester. In contrast, for epidermal growth factor receptor (EGFR)-mutated or anaplastic lymphoma kinase (ALK)-rearranged metastatic lung adenocarcinomas, there is a paucity of clinical data on the safety of EGFR and ALK tyrosine kinase inhibitors to mother and fetus for official guidelines to recommend the use of these otherwise-first-line therapies in pregnancy. Considering this knowledge gap, we present a case of a young gravida 1 para 0 (G1P0) woman who continued alectinib 300 mg oral two times per day for ALK-rearranged metastatic lung adenocarcinoma throughout all 36 weeks of her pregnancy and delivered a healthy baby at term via caesarean section (C-section).

Keywords: ALK; Drugs: obstetrics and gynaecology; Lung cancer (oncology); Pregnancy; Safety.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma of Lung* / drug therapy
  • Anaplastic Lymphoma Kinase / genetics
  • Antineoplastic Agents* / therapeutic use
  • Carbazoles*
  • Carcinoma, Non-Small-Cell Lung* / drug therapy
  • Cesarean Section
  • ErbB Receptors / genetics
  • Female
  • Humans
  • Lung Neoplasms* / pathology
  • Piperidines*
  • Pregnancy
  • Protein Kinase Inhibitors / therapeutic use
  • Receptor Protein-Tyrosine Kinases / metabolism

Substances

  • Anaplastic Lymphoma Kinase
  • alectinib
  • Receptor Protein-Tyrosine Kinases
  • Antineoplastic Agents
  • Protein Kinase Inhibitors
  • ErbB Receptors
  • Carbazoles
  • Piperidines