Narjust Florez: Ready for a Pregnancy and Lung Cancer Tweetorial?

Narjust Florez shared a post on her X/Twitter page:

“Ready for a Pregnancy and Lung Cancer Tweetorial?

1. Epidemiology

• The estimated incidence of cancer in pregnancy is about 1 in 1000.
• Increasing incidence of lung cancer in pregnancy due to advanced maternal age.

2. Characteristics

Most pregnant patients with lung cancer are more likely to:  

• Median age at diagnosis of 35 years.
• Have had minimal or no prior tobacco use.
• Have adenocarcinoma histology.
• Present at an advanced stage due to diagnostic delays.

3. Biomarker Testing

• Genomic testing is ESSENTIAL, as actionable mutations are more likely to be found.
• Single-institution cohort study of patients with Stage IV Non-Small Cell Lung Cancer (NSCLC).
• 2422 female patients.
• 160 women of reproductive age (18-45 years).

4. Biomarker Testing continuation

• 8 pregnant patients; diagnosis made in all trimesters.
• All 8 pregnant patients had targetable molecular alteration: 6 with ALK translocation, 2 with sensitizing EGFR mutation, and were treated with targeted therapy post-delivery.
  PMID: 27296107

5. Approach to Treatment

• No standardized approach for therapy for cancer in pregnancy.
• Important to weigh maternal benefits against potential fetal risks: most of the effects on fetus reported in first trimester.
• Many unanswered questions about the safety of Tyrosine Kinase Inhibitor (TKI) Therapy.

6. Survivorship and Management

• Multidisciplinary approach is important.
• While lung cancer diagnosis is relatively rare in pregnancy or peripartum, it is paramount to perform early evaluation of pregnant women with symptoms concerning for lung cancer.
• Molecular testing should be emphasized.

7. Need for Further Research

More research on pregnancy in lung cancer is required to help:

• Understand safety of targeted therapy.
• Develop standardized treatment regimens.
• Improve maternal and fetal outcomes.
• Early Diagnosis.