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Lung cancer in pregnancy
Kornelia Holzmann1, Roland Kropfmüller, Herwig Schinko
1Department of Pulmonary Medicine, General Hospital Linz (AKH), Linz, Austria, korneliaholzmann@hotmail.com.
Wiener Klinische Wochenschrift
|March 4, 2015
Summary
A pregnant patient with lung adenocarcinoma received chemotherapy and targeted therapy during pregnancy. Despite initial response and successful delivery, the cancer progressed, leading to fatal neoplastic meningeosis.
Area of Science:
- Oncology
- Pulmonology
- Obstetrics
Background:
- A 29-year-old pregnant woman presented with symptoms suggestive of tuberculosis, including cough and hemoptysis.
- Initial investigations ruled out tuberculosis, and further workup revealed advanced lung adenocarcinoma with widespread metastases.
Observation:
- The patient was diagnosed with adenocarcinoma at 26 weeks gestation, with metastases to the spine, bone, and brain.
- Treatment included chemotherapy (docetaxel, carboplatin), radiotherapy, and targeted therapy (gefitinib) due to EGFR mutation.
- A Cesarean section was performed at 30 weeks gestation, followed by neurosurgery for spinal cord compression.
Findings:
- The patient initially responded to gefitinib, with tumor shrinkage observed.
- Despite treatment, she later developed neoplastic meningeosis and cerebral venous sinus thrombosis, indicating disease progression.
- She passed away 17 months after diagnosis.
Implications:
- This case highlights the challenges of managing advanced lung cancer in pregnancy, balancing maternal treatment with fetal well-being.
- The importance of molecular profiling (EGFR mutation) for guiding targeted therapy in pregnant patients with lung adenocarcinoma is demonstrated.
- Multidisciplinary care involving oncology, pulmonology, obstetrics, and neurosurgery is crucial for optimizing outcomes in complex cases.
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