Immune Checkpoint Inhibitor Exposure in Pregnancy: A Scoping Review
Iman Salehi1, Ludmila Porto2, Christine Elser3
1Mount Sinai Hospital.
Abstract:
Since their approval, immune checkpoint inhibitors (ICIs) have become the standard of care for multiple malignancies. ICIs enhance tumor destruction by blocking important immunomodulatory pathways that regulate T-cell activation. These pathways include programmed cell death protein-1 and its ligands (programmed cell death protein-1 and programmed death ligand-1, respectively) and cytotoxic T-lymphocyte-associated protein 4. While blocking these pathways can enhance tumor destruction, these pathways are critical for the development of maternal tolerance towards the fetus. Therefore, if ICIs disrupt these immunomodulatory pathways, there could be a maternal immune response against the fetus, as was found in animal studies. With few reported cases of human pregnancy exposure to ICIs, the effects of ICIs on human pregnancy remain largely unknown. Here, we review and summarize the 6 cases of maternal exposure to immunotherapy that have been published before the present study. To add to the evidence, we present a case series of 2 patients who have been exposed to immunotherapy in pregnancy.
Insights
Immune checkpoint inhibitors (ICIs) used in cancer treatment may disrupt maternal immune tolerance, potentially harming the fetus. This review examines existing human pregnancy exposure cases and adds two new cases to inform clinical understanding.
Area of Science:
- Oncology
- Immunology
- Reproductive Medicine
Background:
- Immune checkpoint inhibitors (ICIs) are standard cancer treatments blocking T-cell regulation pathways.
- These pathways, including PD-1/PD-L1 and CTLA-4, are crucial for maternal immune tolerance during pregnancy.
- Disruption of these pathways by ICIs could trigger maternal immune responses against the fetus.
Observation:
- Animal studies suggest ICIs may trigger maternal immune responses against the fetus.
- Human data on ICI exposure during pregnancy is limited, with only 6 prior cases reported.
- This study reviews existing literature and presents 2 new cases of maternal ICI exposure.
Findings:
- The effects of ICIs on human pregnancy outcomes are not well-established.
- Review of 6 prior cases and 2 new cases provides limited but important clinical data.
- Further research is needed to understand the risks and management of ICIs in pregnant patients.
Implications:
- Understanding ICI effects on pregnancy is critical for oncologists and patients.
- Potential risks to fetal development require careful consideration.
- This work contributes to a growing body of evidence on immunotherapy in pregnancy.
More Related Videos
Related Concept Videos
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:07Teratogenicity