The safety and efficacy for the treatment of alectinib in a women with ALK-positive lung cancer delivered a healthy male neonate throughout Pregnancy: A case report.

The incidence of lung cancer in pregnancy is increasing because of an increase in cigarette smoking among young women, air pollution, and advanced maternal age. This is the third case report of a woman with metastatic anaplastic lymphoma kinase (ALK)-positive lung adenocarcinoma treated with alectinib during pregnancy. The patient was diagnosed with lung cancer at 26 weeks' gestation. Her condition rapidly progressed to disseminated intravascular coagulation accompanied by hypoxemia. After 5 days of treatment with alectinib 600 mg twice daily and best supportive care, the patient's symptoms quickly resolved. She delivered a healthy male newborn at 39 weeks' gestation. At birth, the alectinib concentration was 4.3 times higher in maternal plasma than that in newborn plasma (299.0 vs 69.2 ng/mL). The concentrations of alectinib in the amniotic fluid and the placenta were 27.3 ng/mL and 1136.25 ng/g, respectively. The alectinib concentration in the maternal milk (152 ng/mL) indicated that this drug could be excreted through the breast milk. At 12 months after the diagnosis, the mother had recovered well, and no developmental anomalies were observed in the infant.

Smith­Magenis syndrome in monozygotic twin fetuses presenting with discordant phenotypes and uteroplacental insufficiency.

Smith­Magenis syndrome (SMS) is a rare condition with multiple congenital malformations caused by the haploinsufficiency of RAI1 (deletion or mutation of RAI1). However, the correlation between genotype and phenotype is not well understood. The present study describes the prenatal diagnosis of monozygotic twins with a 17p11.2 deletion, which is indicative of SMS, who presented with discordant phenotypes and uteroplacental insufficiency. A high­resolution genome­wide single nucleotide polymorphism array revealed a 3.7­Mb deletion in the 17p11.2 chromosome region. Accurate breakpoints of the deletion in these patients were used to identify correlations between SMS and the concomitant phenotypes, particularly uteroplacental insufficiency, which has rarely been investigated in SMS. In addition, no exonic mutations were identified in or affected known disease­associated loci that could explain the congenital anomalies, according to a model that accounts for the possibility of incomplete penetrance. Furthermore, a novel benign copy number variation (a duplication of 195 kb at 13q12.13) was identified but was unlikely to be clinically significant in the discordant phenotypes of the twins. The present study showed that multiple interacting genetic and environmental factors are involved in determining the variance of the SMS phenotype.