Use of erlotinib throughout pregnancy: A case-report of a patient with metastatic lung adenocarcinoma

Abstract

The use of erlotinib throughout pregnancy has not been previously reported. We present the case of a 40 year-old female patient with stage IV lung adenocarcinoma, mediastinal, bone and cerebral metastasis, a EGFR mutation and no smoking history, who had begun first line treatment with erlotinib 150 mg once daily. After two and a half months of treatment a fourteen-week pregnancy was documented, and after informing on fetal risks secondary to erlotinib use and maternal risks secondary to treatment withholding, she decided to continue with treatment under clinical surveillance by both the oncology and obstetrics clinics. At thirty-three weeks gestation a live born 1600 g female was born by caesarean section without evidence of congenital malformations. Imaging assessment after eight months of treatment showed complete bone and central nervous system response and partial lung and mediastinal response. The patient is currently undergoing the 11th month of treatment and is asymptomatic, the baby is 4 months old and is in good health.

Introduction

The diagnosis of cancer and pregnancy is an emotional challenge and entails an ethical dilemma for the patient, her family, physicians and society [1]. The incidence of cancer and pregnancy is approximately 1 in 1000 pregnancies [2]. To our knowledge only 44 cases of women with lung cancer during pregnancy have been published, more than 80% corresponding to stages III and IV, with a median survival of 4.5 months. Only 9 achieved survival larger than 1 year and 26% had documented metastasis to the products of conception [1], [3]. There is only one report on the use of erlotinib during the first 8 weeks of gestation [4].

We report on the first case of a patient with stage IV lung adenocarcinoma in whom a fourteen-week pregnancy had been documented under erlotinib treatment. The patient has achieved partial response, and the baby is in good health.