Posted: Thursday, February 1, 2024
An article published in the Journal of Thoracic Oncology focused on alterations in the actionable lung cancer oncogenes EGFR, ALK, and ROS1, which can occur across the age spectrum of patients with oncogene-driven non–small cell lung cancer (NSCLC). It is possible for pregnancy and plans for motherhood to overlap with this diagnosis.
“Accessible data on targeted lung cancer therapy during pregnancy or egg retrieval [have] not been collated previously, nor have the issues of reproduction in the setting of specific oncogene-addicted advanced NSCLC been widely discussed,” stated Emily Simons, MD, MPH, and D. Ross Camidge, MD, PhD, of the University of Colorado Cancer Center, Aurora. “Reproduction may not be out of reach for some patients with advanced NSCLC.”
Drs. Simons and Camidge performed a narrative review of ex vivo placenta perfusion studies, pharmacologic characteristics, mutagenicity, and animal embryofetal development studies. They also reviewed case reports of pathways to motherhood, pregnancies, and egg retrieval while patients were on EGFR-, ALK-, or ROS1-targeted therapy.
Among their findings were the fact that EGFR inhibitors may reduce female fertility during therapy because of decreased corpora lutea. Based on potential increases in post-implantation loss observed in animals, the odds of pregnancy in women on EGFR and ALK inhibitors may be reduced. Several effects on human pregnancies have been noted; however, 11 EGFR and ALK tyrosine kinase inhibitor–exposed infants have been documented as being free of significant adverse health effects by the ages of 4 months to 2 years. Successful gestational surrogacy has been reported in two women treated with crizotinib.
Drs. Simons and Camidge believe further study is warranted on the impact and optimal timing of targeted therapy in egg capture and in pregnancy. Also needed, they added, are wider scientific and societal discussions about the issue of reproduction in patients with advanced lung cancer.
Disclosure: For full disclosures of the authors, visit www.jto.org.