Pregnancy in a patient with metastatic functioning midgut neuroendocrine tumor receiving lanreotide after peptide receptor radionuclide therapy.

Abstract

Neuroendocrine tumors (NETs) are rare neoplasms that present significant challenges during pregnancy, particularly in the context of metastatic disease or carcinoid syndrome requiring systemic therapy. Data on the safety of somatostatin analogs during pregnancy remain limited and are primarily derived from studies involving patients with acromegaly. We report the maternal and fetal outcomes in a pregnant patient diagnosed with a metastatic NET of the ileocecal valve, complicated by carcinoid syndrome. The patient had previously undergone treatment with 177Lu-DOTATATE, debulking surgery, and lanreotide therapy. Lanreotide administration was continued throughout the pregnancy under multidisciplinary supervision. Maternal monitoring revealed no complications, and postpartum evaluations confirmed disease stability. The newborn developed transient neonatal hyperbilirubinemia requiring phototherapy but demonstrated normal development at the 18-month follow-up. This case highlights important clinical considerations regarding the continuation of somatostatin analog therapy, biochemical monitoring, peri-delivery planning for a carcinoid crisis, and pregnancy after peptide receptor radionuclide therapy in patients with functioning metastatic NETs. It provides supportive observational evidence that the continuation of lanreotide during pregnancy may be feasible in carefully selected patients under close multidisciplinary supervision, although conclusions regarding safety remain limited by the rarity of available data.