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Ref Type Journal Article
PMID (40441332)
Authors Yao Z, Tang M, Jin Y, Ruan J, Hu Y, Xie H, Wang Z, Fu L, Huang X, Zhou X, Zou B, Liu G, Zheng L, Lu Y
Title Brief Report: Successful Pregnancy and Healthy Baby Outcome in a TKI-refractory ALK+ NSCLC Patient with CNS Metastasis Treated with Lorlatinib with Maternal-fetal Pharmacokinetics and Child Milestone Development Correlations.
Journal Vol Issue Date Pages Journal Short Title
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2025 May 27 J Thorac Oncol
URL
Abstract Text Lorlatinib is the preferred first-line treatment for advanced anaplastic lymphoma kinase (ALK)+ non-small cell lung cancer (NSCLC) based on the 5-year CROWN update. However, the effects of lorlatinib on the fetus and neonate remain unknown.We report the first case of a patient with metastatic ALK-positive NSCLC who became pregnant during treatment with lorlatinib. A literature review was performed to identify all previously reported pregnancies of ALK-positive NSCLC. The collection, determination, and analysis of lorlatinib pharmacokinetics and mass spectroscopy imaging of lorlatinib are both performed.A 33-year-old pregnant woman, with a 7-year history of ALK-positive mNSCLC, was admitted to the hospital with brain metastases recurrence at 20 weeks of gestation. She self-discontinued lorlatinib at 4 weeks of gestation after long-term disease control on a reduced dose. According to patient's preference, low dose lorlatinib was re-introduced at 20 weeks, with successful tumor control and normal fetal growth. At 20-month follow-up post-partum, the mother maintained intracranial and systemic remission and no congenital abnormalities were observed in the baby. Pharmacokinetic analyses and mass spectroscopy imaging peri-delivery confirmed placental transfer of lorlatinib.The case highlights both the potential safety and safety concerns with the use of lorlatinib during pregnancy, along with the unique nature of CNS-dominant ALK-positive NSCLC, the potential clinical utility of dose-reduced lorlatinib.

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