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C. Verschraegen

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    P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P1.01-037 - Successful Treatment of Non-Small Cell Lung Cancer with Erlotinib throughout Pregnancy (ID 720)

      09:30 - 17:00  |  Author(s): C. Verschraegen

      • Abstract

      Erlotinib is the standard of care for epidermal growth factor receptor (EGFR) mutated lung adenocarcinomas in the USA. However, in pregnant patients with lung cancer, chemotherapy is recommended, irrespective of EGFR mutations, given the lack of experience and uncertainty for fetus’ safety with Erlotinib.

      A patient, with twin pregnancy after in-vitro fertilization, was intentionally treated with Erlotinib. Pharmacokinetics of Erlotinib and its active metabolite (OSI240) were measured in mother’s plasma and twins’ cord blood which were collected at delivery. Times of gestation, fetal growth, transplacental pharmacokinetics of Erlotinib, and cancer outcome were recorded. The pharmacovigilance of Erlotinib during pregnancy was analyzed by accessing Roche/Genentech global database.

      A 47 year old woman, ten-weeks pregnant with twins, was diagnosed with stage 4 lung cancer which harbored an exon 19 deletion. She had brain metastases which were treated with stereotactic surgery during the first trimester. Erlotinib -150 mg daily - was intentionally administered at the start of the second trimester. She was treated for 130 days. Growth retardation was noted in one fetus at week 33 and delivery was planned at week 37 by cesarean section. Drug concentrations in mother's plasma and twins'cord blood are shown in the table. Erlotinib and its metabolite cross the placenta, but only at 10-25% of blood concentrations. Side effects included a lower than expected birth weight (87% of normal) and transaminitis in both newborns that resolved within 3 months. The mother sustains an ongoing partial response to Erlotinib with minor skin rash and fatigue from treatment. The infants are normal at 10 months. Table 1. Erlotinib Concentrations in Mother and Twins

      Sample Erlotinib concentration (ng/mL) % OSI-420 concentration (ng/mL) % Newborn weight (g)
      Mother plasma 54.31 100 16.25 100 -
      Newborn A cord 13.67 25.2 2.12 13.0 2353
      Newborn B cord 12.18 22.4 1.5 9.2 2438
      OSI-420, Desmethyl-Erlotinib.

      Erlotinib administration is feasible during late pregnancy and yields improved cancer outcome.