A pregnant patient with ALK-positive non-small cell lung cancer treated with alectinib: A case report and review of the literature

Abstract

Oncogenic rearrangements in the anaplastic lymphoma kinase (ALK) gene account for 5% of non-small cell lung cancer (NSCLC) cases. ALK inhibitors have markedly improved the outcome of metastatic ALK-positive NSCLC (ALK⁺ mNSCLC) by increasing long-term overall survival. Although a diagnosis of NSCLC during pregnancy or the peripartum period is rare, ALK⁺ NSCLC accounts for 38% of NSCLC cases in women of childbearing age (18-45 years old). The younger age and prolonged survival of patients with ALK⁺ mNSCLC bring new challenges for lung cancer and obstetrics research, and raises questions related to pregnancy and family planning. The present study described normal fetal development and no obstetric complications in a patient infected with HIV diagnosed with ALK⁺ mNSCLC, who became pregnant during treatment with alectinib, a third-generation ALK inhibitor.

Keywords: alectinib; anaplastic lymphoma kinase gene; lung cancer; pregnancy.

Figure 1.

Fetal magnetic resonance imaging at 32 weeks, axial view of the fetal brain (TSE, T2), normal gyration and brain parenchyma.

Figure 2.

Macroscopical evaluation of placental plate was normal and did not show any lesion.

Figure 3.

The histological evaluation is characterized by normal developed villi on regard of the gestational age. No signs of thrombosis, inflammation or infiltration by the tumor have been observed (Hematoxylin and eosin; magnification, ×5).

Figure 4.

Chest CT scan postpartum: Stability of the lung lesions.