Metastatic ALK Positive Lung Adenocarcinoma in Pregnancy: Navigating Maternal Treatment, Fetal Safety and Timing of Delivery

Abstract

Background: Managing metastatic anaplastic lymphoma kinase (ALK)-positive lung adenocarcinoma during pregnancy requires careful consideration of maternal cancer control, potential fetal treatment exposure and the timing of delivery. Evidence to guide treatment decisions remains limited. Case Presentation: A 23-year-old woman receiving ceritinib for metastatic ALK-positive, epidermal growth factor receptor (EGFR)-negative lung adenocarcinoma conceived unexpectedly. Ceritinib was withheld. Following multidisciplinary counselling and an unsuccessful attempt at medical termination, the patient elected to continue the pregnancy. Carboplatin–paclitaxel chemotherapy was administered during the second trimester. After three cycles, imaging demonstrated recurrent pleural effusion and new spinal metastases with nerve impingement, indicating disease progression. A multidisciplinary team planned early delivery, and an infant weighing 1.0 kg was delivered by emergency caesarean section at 29 weeks of gestation after antenatal corticosteroid administration. On postpartum day 12, brain imaging demonstrated intracranial metastases, and ceritinib treatment was resumed. At five months postpartum, the mother was receiving lorlatinib and had clinically and radiologically controlled disease, without new metastatic lesions. The infant had been discharged following neonatal intensive care, was gaining weight appropriately and no longer required oxygen supplementation. Conclusion: This case illustrates the difficult decisions involved when advanced maternal malignancy progresses during pregnancy. Individualised counselling, multidisciplinary coordination, maternal–fetal surveillance and careful delivery planning remain central to management, while the fetal safety of targeted anticancer therapy remains uncertain.