Abstract
Congenital abnormalities caused by human teratogenic drugs account for less than 1% of total congenital abnormalities. We report the first case of multiple anomalies associated with antenatal exposure to the anticancer agent Gefitinib. The patient conceived while she was on tablet Gefitinib 250 mg once a day for stage IV adenocarcinoma of lungs. The first scan done at 29 weeks 2 days showed liquor amnii on the upper limit of normal, single umbilical artery, left sided congenital diaphragmatic hernia, ventriculoseptal defect and left radial ray defect. The patient had a preterm delivery after one week and she refused autopsy. It is important to advise patients regarding contraception while undergoing chemotherapy as there is an increased risk of drug induced fetal malformations.
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References
American Academy of Pediatrics: Congenital abnormalities. https://www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/Pages/Congenital-Abnormalities.aspx (2015). Accessed 21 Apr 2017.
Sharma R. Birth defects in India: hidden truth, need for urgent attention. Indian J Hum Genet. 2013;19(2):125–9. https://doi.org/10.4103/0971-6866.116101.
Bullers K. Merck manuals. J Med Libr Assoc. 2016;104(4):369–71. https://doi.org/10.3163/1536-5050.104.4.028.
Sorensan MK, Phillips BB, Mutnick AH. Drug use in specific patient populations: Pediatric, Pregnant, Geriatric. In: Shargel L, Mutnick A, editors. Comprehensive Pharmacy Review. 5th ed. Philadelphia: Lippincott William Wilkins; 2004. p. 673–82.
Wo H, He J, Zhao Y, Yu H, Chen F, Yi H. The efficacy and toxicity of gefitinib in treating non-small cell lung cancer: a meta-analysis of 19 randomized clinical trials. J Cancer. 2018;9(8):1455–65.
Sachdeva P, Patel BG, Patel BK. Drug use in pregnancy; a point to ponder! Indian J Pharm Sci. 2009;71(1):1–7. https://doi.org/10.4103/0250-474X.51941.
FDA Consumer Articles. Pregnant? Breastfeeding? Better Drug Information Is Coming. https://www.fda.gov/consumers/consumer-updates/pregnant-breastfeeding-better-drug-information-coming. Accessed 1 Aug 2019.
FDA/CDER SBIA Chronicles. Drugs in Pregnancy and Lactation: Improved Benefit-Risk Information. Accessed August 1, 2019 at https://www.fda.gov/files/drugs/published/%22Drugs-in-Pregnancy-and-Lactation--Improved-Benefit-Risk-Information%22-January-22--2015-Issue.pdf. Accessed 1 Aug 2019.
FDA News Release. FDA issues final rule on changes to pregnancy and lactation labeling information for prescription drug and biological products. https://www.fda.gov/drugs/labeling/ pregnancy-and-lactation-labeling-drugs-final-rule. Accessed 1 Aug 2019.
Mospan C, New Prescription Labeling Requirements for the Use of Medications in Pregnancy and Lactation. CE for Pharmacists. The Ohio Pharmacist Foundation. https://cdn.ymaws.com/www.wsparx.org/resource/resmgr/CE_Magazine/WA_0416_State_CE_Lesson.pdf. Accessed 1 Aug 2019.
Product information for AusPAR Gefitinib AstraZeneca Pty Ltd PM-2009-02058-3-4 Final 29 June 2010.
Boussios S, Han SN, Fruscio R, Halaska MJ, Ottevanger PB, Peccatori FA, Koubková L, Pavlidis N, Amant F. Lung cancer in pregnancy: report of nine cases from an international collaborative study. Lung cancer. 2013;82(3):499–505.
Ji Y, Schwartz J, Hartford A, Ramsey J, Phillips J, Verschraegen C. Successful treatment of non-small cell lung cancer with erlotinib throughout pregnancy. JAMA Oncol. 2015;1:838–40 (Niebyl, J, Simpson, J, Glob. Libr. Women’s med.,).
Zambelli A, Prada GA, Fregoni V, Ponchio L, Sagrada P, Pavesi L. Erlotinib administration for advanced non-small cell lung cancer during the first 2 months of unrecognized pregnancy. Lung Cancer. 2008;60:455–7.
Lee CH, Liam CK, Pang YK, Chua KT, Lim BK, Lai NL. Successful pregnancy with epidermal growth factor receptor tyrosine kinase inhibitor treatment of metastatic lung adenocarcinoma presenting with respiratory failure. Lung Cancer. 2011;74:349–51.
Rivas G, Llinás N, Bonilla C, Rubiano J, Cuello J, Arango N. Use of erlotinib throughout pregnancy: a case-report of a patient with metastatic lung adenocarcinoma. Lung Cancer. 2012;77:469–72.
Peccatori FA, Azim HA Jr, Orecchia R, et al. Cancer, pregnancy and fertility: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24:vi160-70.
JJCO Japanese Journal of Clinical Oncology Japanese Journal of Clinical Oncology, 2016;46(9):795–804 doi: 10. 1093/jjco/hyw073 Review Article Anticancer drugs during pregnancy Shingo Miyamoto1. Accessed 9 June 2016.
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Joshi, M., Gopinath, P.M. & Kalaichelvi, K. Anticancer Agent Gefitinib and Congenital Anomalies. J. Fetal Med. 7, 289–293 (2020). https://doi.org/10.1007/s40556-020-00275-2
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DOI: https://doi.org/10.1007/s40556-020-00275-2