2022 World Conference on Lung Cancer (ePosters)-EP08.02-087. A 28-Years Old Pregnant Woman Diagnosed as ALK-Rearrangement Lung Adenocarcinoma With Multiple Brain Metastasis

EP08.02-087. A 28-Years Old Pregnant Woman Diagnosed as ALK-Rearrangement Lung Adenocarcinoma With Multiple Brain Metastasis - Case Report

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A case report was presented of a 28-year-old pregnant woman who was diagnosed with ALK-rearrangement lung adenocarcinoma with multiple brain metastases. ALK gene rearrangement is found in 3-7% of non-small cell lung cancer (NSCLC) patients, particularly in younger women and non-smokers with adenocarcinoma. The incidence of lung cancer among pregnant women has slightly increased due to smoking and older age at the time of first pregnancy. <br /><br />The patient, a non-smoker at 37 weeks gestation, experienced sudden confusion, nausea, and memory impairment and was referred to the gynecology and obstetrics department. She underwent an acute C-section and her neurological symptoms worsened, leading to the discovery of multiple metastatic brain lesions. A CT scan also revealed a primary lung tumor and suspected liver metastasis. Biopsy confirmed lung adenocarcinoma with EML4-ALK rearrangement.<br /><br />The patient received whole-brain radiotherapy and was subsequently started on ALK TKI (alectinib) treatment. After four weeks, brain metastases significantly regressed, and the primary tumor showed partial remission. However, after eleven months, a new skeletal metastasis in the left ilium was found. The treatment was switched to the third generation ALK-TKI lorlatinib, but severe hyperlipidemia led to treatment discontinuation.<br /><br />Chemotherapy with pemetrexed-cisplatin was initiated in January 2022 and is ongoing. The case highlights the significant effects of second and third-generation ALK-TKIs in advanced lung adenocarcinoma and emphasizes the importance of molecular-genetic investigation in young non-smokers with advanced lung adenocarcinoma. It also underscores the need to consider malignancy as a possible differential diagnosis during pregnancy, even with nonspecific symptoms.

Asset Subtitle

Simona Laštíkova

Meta Tag

Speaker Simona Laštíkova

Topic Metastatic Non-small Cell Lung Cancer - Molecular Targeted Treatments

Keywords

case report

pregnant woman

ALK-rearrangement lung adenocarcinoma

brain metastases

ALK gene rearrangement

non-small cell lung cancer

NSCLC

young women

non-smokers

adenocarcinoma