Pausing Alectinib During Pregnancy After a Complete Lung Cancer Response

What happened, in summary

A woman in her 20s who had never smoked developed night sweats, coughing up blood and mild shortness of breath soon after starting treatment for a new HIV diagnosis. Lung lesions and enlarged lymph nodes initially raised concern for an opportunistic infection, but the investigation confirmed metastatic non-small cell lung cancer.

After a pregnancy test was negative, she started alectinib 600 mg twice daily. Three months later, the lung nodules had completely regressed, the pleural effusion had resolved and the enlarged lymph nodes had decreased in size and number. After another 3 months of treatment, she noticed that her period was late. Blood testing and ultrasound showed that she was already 19 weeks pregnant.

Doctors discussed termination because fetal exposure to alectinib could carry unknown risks, but she chose to continue the pregnancy. Since her cancer had responded completely, the team agreed to stop alectinib temporarily, follow both mother and fetus closely, and restart treatment after delivery. Repeated ultrasound and MRI examinations showed normal growth, anatomy and amniotic fluid.

At 36 weeks, she went into spontaneous labor and delivered a healthy girl weighing 3,200 g and measuring 50 cm. A chest CT after delivery showed that the complete cancer response had been maintained. Alectinib was restarted, and she was advised not to breastfeed because the medicine could enter breast milk.

At 32 months of follow-up, she remained in complete remission without treatment-related side effects. Her child was developing normally physically and in age-appropriate movement and learning skills.