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. 2021 Jul;13(7):4125-4136.
doi: 10.21037/jtd-21-234.

Clinical features and intervention timing in patients with pregnancy-associated non-small-cell lung cancer

Lei Yang  1   2 , Yun-Ting He  1   2 , Jin Kang  2 , Ming-Ying Zheng  2 , Zhi-Hong Chen  2 , Hong-Hong Yan  2 , Xu-Chao Zhang  2 , Jin-Ji Yang  2 , Yi-Long Wu  2 , Qing Zhou  1   2
Affiliations

Clinical features and intervention timing in patients with pregnancy-associated non-small-cell lung cancer

Lei Yang et al. J Thorac Dis. 2021 Jul.

Abstract

Background: There is no standard procedure available to diagnose and treat with pregnancy-associated non-small cell lung cancer (NSCLC). The present study was to investigate the clinical and molecular features, and the proper intervention timing for this population.

Methods: This is a retrospective, pooled analysis. Cases from Guangdong Lung Cancer Institute and other published cases were collected and reviewed. The overall survival (OS) was analyzed according to the diagnosis timing, the treatment timing and the molecular character. The safety profile during pregnancy was also evaluated.

Results: Seventy-seven cases were collected including 11 patients from our center. The anaplastic lymphoma kinase (ALK) gene rearrangement and epidermal growth factor receptor (EGFR) mutation rates were 47% and 32%, respectively. The OS of patients treated during pregnancy, after delivery, and those not treated differed significantly [12 months vs. not reached (NR) vs. 1 month; P<0.001]. However, the OS between patients treated during pregnancy and after delivery was similar (P=0.173). Patients with ALK or EGFR exhibited a significantly better OS than those with wild-type [NR vs. 22 months vs. 8 months; P<0.001; hazard ratio (HR) =0.02, 95% confidence interval (CI): 0.00-0.22; HR =0.08, 95% CI: 0.01-0.76]. Fetal complications were observed in babies whose mothers were treated during pregnancy.

Conclusions: The pregnancy-associated NSCLC population exhibited a high prevalence of driver genes and a promising effect of targeted therapy. No significant difference in the OS was observed between patients treated during pregnancy and patients treated after delivery.

Keywords: Non-small cell lung cancer (NSCLC); intervention timing; molecular pathology; pregnancy; survival.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-21-234). QZ declares speaker fees from AstraZeneca, and Roche. YLW declares speaker fees from AstraZeneca, Eli Lilly, Pfizer, Roche, and Sanofi. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Diagram describing the cases selection.
Figure 2
Figure 2
OS of patients initiated anticancer treatment during pregnancy, after delivery, no treatment. (I) Treated during pregnancy vs. treated after delivery vs. no treatment (12 months vs. NR vs. 1 months; P<0.001). (II) Treated during pregnancy vs. treated after delivery (12 months vs. NR; P=0.173; HR =1.75, 95% CI: 0.74 to 4.13). OS, overall survival; NR, not reached; HR, hazard ratio; CI, confidence interval.
Figure 3
Figure 3
OS of patients with EGFR mutation, ALK mutation and wild-type. OS, overall survival; EGFR, epidermal growth factor receptor; ALK, anaplastic lymphoma kinase; NR, not reached; HR, hazard ratio; CI, confidence interval.
See this image and copyright information in PMC

Comment in

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