Two young women diagnosed with metastatic, <i>KRAS</i> G12D-mutant lung adenocarcinoma during pregnancy

Introduction: Cancer diagnosis during pregnancy is rare, but the incidence is expected to rise. Lung cancer during pregnancy is often diagnosed at an advanced stage, with overall poor prognosis. Symptoms are often attributed to alternative diagnoses or physiological changes of pregnancy. Diagnostic imaging is also sometimes delayed due to concerns regarding the hazardous effects of radiation exposure on the fetus. Case Series: We present two cases of patients diagnosed with metastatic lung adenocarcinoma during pregnancy. Neither patient had a targetable mutation for treatment, but were found to have KRAS G12D-mutation. Both patients were started on carboplatin, pemetrexed, and pembrolizumab after delivery of their babies. They both died a few months post-diagnosis. Conclusion: Evidence regarding management of lung cancer in pregnancy is limited, based on case reports and no randomized control trials. This case series highlights the importance of clinicians having a low threshold to investigate for cancer in pregnancy, to aid earlier diagnosis and improve prognosis.