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Use of tyrosine kinase inhibitors during pregnancy for oncogenic-driven advanced non-small cell lung carcinoma
Lung Cancer ( IF 5.3 ) Pub Date : 2021-09-11 , DOI: 10.1016/j.lungcan.2021.09.001
Anne-Sophie Boudy 1 , Noémie Grausz 2 , Lise Selleret 1 , Joseph Gligorov 3 , Isabelle Thomassin-Naggara 4 , Cyril Touboul 5 , Emile Daraï 5 , Jacques Cadranel 6
Affiliation  

Introduction

Lung cancer associated with pregnancy is rare but on the increase. The use of tyrosine kinase inhibitor (TKI) therapy for advanced oncogenic-driven non-small cell lung carcinoma (NSCLC) has improved overall survival. Oncological and obstetric outcomes of patients diagnosed with NSCLC and treated by TKIs during pregnancy have been poorly evaluated.

Methods

Three cases of NSCLC treated by TKIs during pregnancy were collected from the prospective database of the Cancer Associé à La Grossesse (CALG) network (France) in addition to eight cases identified by a systematic review performed between 2000 and 2021.

Results

Among the eleven reported patients, six received an EGFR- and five an ALK-TKI. All patients were young nonsmokers and four had brain metastases at diagnosis. TKI treatment was initiated during the first trimester for three patients. Premature delivery was induced in 10/11 patients. Anamnios occurred in one patient treated by osimertinib and trastuzumab. Five newborns were hypotrophic. No newborn malformations were observed. Diffusion of the TKIs, confirmed by blood cord sampling, represented about 1/3 (EGFR-TKI) and 1/8 (ALK-TKI) of the maternal concentration. No developmental abnormalities were observed in the children (follow-up 30 months). The anti-tumor efficacy and tolerance of TKIs, when reported, appears similar to that described in the general population.

Conclusions

Our results support the rationale for using TKIs during pregnancy, both in terms of maternal NSCLC disease control and the relatively mild effects on the fetus. Our data will serve to better inform patients about the risks associated with TKIs used during pregnancy, contributing to shared decision making.



中文翻译:

孕期使用酪氨酸激酶抑制剂治疗致癌驱动的晚期非小细胞肺癌

介绍

与怀孕相关的肺癌很少见,但呈上升趋势。使用酪氨酸激酶抑制剂 (TKI) 治疗晚期致癌驱动的非小细胞肺癌 (NSCLC) 提高了总生存率。诊断为非小细胞肺癌并在怀孕期间接受 TKI 治疗的患者的肿瘤学和产科结果评价不佳。

方法

除了 2000 年至 2021 年期间进行的系统评价确定的 8 例病例之外,还从癌症协会 (CALG) 网络(法国)的前瞻性数据库中收集了 3 例妊娠期间接受 TKI 治疗的 NSCLC 病例。

结果

在报告的 11 名患者中,6 名接受了 EGFR-TKI,5 名接受了 ALK-TKI。所有患者都是年轻的非吸烟者,其中 4 人在诊断时有脑转移。三名患者在妊娠头三个月开始 TKI 治疗。10/11 患者诱发了早产。一名接受奥希替尼和曲妥珠单抗治疗的患者发生了羊水。五名新生儿营养不良。未观察到新生儿畸形。经脐带取样证实的 TKI 扩散约占母体浓度的 1/3 (EGFR-TKI) 和 1/8 (ALK-TKI)。在儿童中未观察到发育异常(随访 30 个月)。TKI 的抗肿瘤功效和耐受性在报告时与一般人群中描述的相似。

结论

我们的结果支持在怀孕期间使用 TKI 的基本原理,无论是在母体 NSCLC 疾病控制方面还是在对胎儿的相对轻微影响方面。我们的数据将有助于更好地告知患者与怀孕期间使用的 TKI 相关的风险,从而有助于共同决策。

更新日期:2021-09-19
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