Checkpoint inhibitors, fertility, pregnancy, and sexual life: a systematic review

Area of Science:

• Oncology
• Immunotherapy
• Reproductive Medicine

Background:

• Immune checkpoint inhibitors (ICIs), including anti-PD1, anti-PDL1, and anti-CTLA4 therapies, have transformed cancer treatment, leading to durable responses in some metastatic patients.
• The potential for cure and treatment discontinuation strategies arise from long-term efficacy, prompting interest in patients' reproductive plans.
• Immunotherapy's use is expanding to early-stage cancers prevalent in younger populations, heightening concerns about reproductive health.

Purpose of the Study:

• To systematically review and consolidate existing data on the effects of ICIs on fertility, pregnancy, and sexual function.
• To provide clinicians with evidence-based information for managing patients undergoing ICI therapy.
• To guide future research on the reproductive safety of immunotherapies.

Main Methods:

• A systematic literature search was performed to identify studies investigating fertility, pregnancy, and sexual adverse events associated with ICIs.
• Data extraction focused on reported outcomes related to reproductive health in patients treated with anti-PD1, anti-PDL1, or anti-CTLA4 agents.

Main Results:

• Evidence regarding the impact of ICIs on fertility, pregnancy, and sexuality remains limited.
• Specific adverse effects on reproductive organs and outcomes during pregnancy require further detailed investigation.
• The long-term consequences of ICI exposure on reproductive health are not yet fully elucidated.

Conclusions:

• There is a critical need for more research into the effects of immune checkpoint inhibitors on fertility, pregnancy, and sexual health.
• Understanding these effects is crucial for informed patient counseling and clinical decision-making.
• Future studies should prioritize prospective data collection on reproductive outcomes in patients receiving ICI therapy.