Clinicopathologic Features of NSCLC Diagnosed During Pregnancy or the Peripartum Period in the Era of Molecular Genotyping.
Cancer will be diagnosed in one in 1000 women during pregnancy. The outcomes of NSCLC diagnosed during pregnancy are dismal, with most patients dying within 1 year. Actionable mutations are more likely to be found among younger patients with NSCLC. However, most previous reports of NSCLC diagnosed during pregnancy did not include molecular genotyping.



We performed a retrospective analysis of patients seen at our institution between 2009 and 2015 to identify women in whom NSCLC was diagnosed during pregnancy or the peripartum period and determined clinicopathologic features, including molecular genotype.



We identified 2422 women with NSCLC, including 160 women of reproductive age. Among the women of reproductive age, eight cases of NSCLC diagnosed during pregnancy or the peripartum period were identified; all were diagnosed in minimal or never-smokers with metastatic adenocarcinoma. Six of these patients were found to have anaplastic lymphoma kinase gene (ALK) rearrangements, whereas the remaining two were EGFR mutation positive. We observed a borderline significant association between a diagnosis of NSCLC during pregnancy or the peripartum period and ALK positivity (p = 0.053). All eight women in whom NSCLC was diagnosed during pregnancy or the peripartum period received treatment with genotype-directed therapies after delivery. The median overall survival has not been reached at a median follow-up of 30 months.



Although a diagnosis of NSCLC during pregnancy or the peripartum period is rare, diagnostic evaluation should not be delayed in pregnant women presenting with symptoms worrisome for lung cancer. Evaluation should include testing for targetable molecular alterations.
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Ibiayi
I
Dagogo-Jack
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Justin F
JF
Gainor
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Rebecca L
RL
Porter
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Katherine R
KR
Schultz
Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Benjamin J
BJ
Solomon
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Sara
S
Stevens
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Christopher G
CG
Azzoli
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Lecia V
LV
Sequist
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Inga T
IT
Lennes
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: ashaw1@partners.org.
Alice T
AT
Shaw
D000328:Adult; D000077548:Anaplastic Lymphoma Kinase; D002289:Carcinoma, Non-Small-Cell Lung / Q000201:enzymology / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D015321:Gene Rearrangement; D005838:Genotype; D006801:Humans; D008175:Lung Neoplasms / Q000201:enzymology / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D058725:Peripartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000201:enzymology / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D011644:Puerperal Disorders / Q000201:enzymology / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D012189:Retrospective Studies
C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases
ALK; EGFR; Lung cancer; Pregnancy