Elsevier

Lung Cancer

Volume 59, Issue 2, February 2008, Pages 270-273
Lung Cancer

Case report
Docetaxel, gemcitabine, and cisplatin administered for non-small cell lung cancer during the first and second trimester of an unrecognized pregnancy

https://doi.org/10.1016/j.lungcan.2007.06.017Get rights and content

Summary

Although several chemotherapeutic agents have been proven to be safe for the fetus after the organogenesis period, there is limited information on their use during the first trimester of pregnancy. We here report the first case of a patient with lung cancer who was treated with platinum-based chemotherapy from the first trimester of an unrecognized pregnancy. A 35-year-old woman was diagnosed with stage IV non-small cell lung cancer with brain metastasis. Since she recalled the date of her last menstrual period at about 20 days prior to consult, we did not consider the possibility of conception at the time of diagnosis. With an object of controlling the increased intracranial pressure, we initially performed a craniotomy with tumor removal, followed by whole brain irradiation. Without our knowledge of her pregnancy, she received a palliative chemotherapy with docetaxel and cisplatin followed by gemcitabine and cisplatin as the second-line chemotherapeutic agents between weeks 9 and 22 of gestation. Follow-up computed tomographic scans performed 2 months after the last chemotherapy showed a fetus in the patient's abdomen. Cesarean section was performed at 33 weeks of gestation, delivering a 1490 g female newborn with no evidence of congenital malformations.

Introduction

Lung cancer is one of the most common forms of cancer in the world, both in terms of incidence and mortality. Non-small cell lung cancer accounts for at least 80% of all lung cancer cases, presenting as locally advanced or metastatic disease in approximately 65–80% of cases [1]. Platinum-based combination chemotherapy remains the standard treatment for patients with advanced non-small cell lung cancer. Although lung cancer develops more frequently among patients in their sixth or seventh decades of life with a male preponderance, its incidence in individuals younger than 40 years has increased recently, especially in women [2].

The occurrence of malignancies during pregnancy has increased over the last decades. They complicate approximately 1 per 1000 pregnancies [3]. The most common malignancies associated with pregnancy include malignant melanoma, malignant lymphoma, leukemia, and cancer of the cervix, breast, ovary, and colon [3]. Lung cancer diagnosed during pregnancy is rare. Although the number of reported cases has been escalating in recent years [2], [4], [5], [6], the incidence of lung cancer during pregnancy is unknown. Up to now around 25 cases of lung cancer in pregnant women have reported in the English literature. Interestingly, a recent study reported that lung cancer in pregnancy was among the tumours that invade commonly the products of conception [5]. To our knowledge, however, information on the use of chemotherapeutic agents for lung cancer during pregnancy is limited to one case report with a woman receiving vinorelbine and cisplatin in the third trimester [6].

Most chemotherapeutic drugs possess significant teratogenic or abortifacient effects. Although several agents have been proven to be safe for the fetus after the organogenesis period [7], there is limited information on their use during the first trimester of pregnancy [8]. We here report the first patient with metastatic non-small cell lung cancer (NSCLC) who was treated with platinum-based chemotherapy from the first trimester of pregnancy.

Section snippets

Case report

A 35-year-old woman was referred to our hospital because of headache during the preceding 2 months. Her headache initially responded with non-steroidal anti-inflammatory drugs. But this symptom worsened over the latest several days, with nausea and vomiting being accompanied whenever she bends forward. She had no allergies or significant past medical history, and her family history was unremarkable. She lived with her husband as a housekeeper for 10 years and had two children. She did not smoke

Discussion

Diagnosis of cancer in a woman with pregnancy must be a devastating event with medical and ethical dilemmas accompanied by maternal-fetal conflict. The majority of available chemotherapeutic drugs are considered to have an undefined or definite evidence of fetal risk. Therefore, chemotherapy should be delayed until the second or third trimester to minimize the risk of fetal malformation. In this case, however, we did not recognize the pregnancy until the third trimester of pregnancy. As a

Conflicts of interest

None declared.

References (17)

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    Citation Excerpt :

    All exposures were during the 2nd and 3rd trimester and except for one case of ventriculomegaly during the 2nd trimester no fetal malformations were reported [60]. Two cases of fetal exposure to cisplatin during the 1st trimester have also been reported [61,62]. In one of these cases, the newborn was exposed to Dartmouth regimen (tamoxifen, dacarbazine, carmustine, cisplatin) and microphthalmos was noted [62].

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