Female Oncofertility and Immune Checkpoint Blockade in Melanoma: Where Are We Today?

Area of Science:

• Oncology
• Reproductive Medicine
• Immunotherapy

Background:

• Melanoma incidence is rising in young adults, but mortality is decreasing due to immune checkpoint inhibitors (ICI).
• Peri-operative ICI, particularly PD-1 inhibitors, improves relapse-free survival in high-risk melanoma.
• Increased ICI use raises concerns about fertility and reproductive health in women of childbearing potential.

Purpose of the Study:

• To review oncofertility practices in female melanoma patients post-immunotherapy.
• To identify literature gaps regarding ICI's impact on reproductive health and fetal development.
• To synthesize evidence on pregnancy planning and recurrence risks after melanoma treatment.

Main Methods:

• Literature review focusing on oncofertility in melanoma patients treated with ICI.
• Synthesis of data on ICI toxicities, fertility preservation, and pregnancy outcomes.
• Analysis of melanoma recurrence risks in the context of pregnancy and immunotherapy.

Main Results:

• Limited human data exists on maternal and fetal toxicities of ICI during pregnancy.
• Uncertainty surrounds fertility preservation efficacy and pregnancy outcomes post-adjuvant immunotherapy.
• The distinct nature of pregnancy-associated melanoma (PAM) and its management requires further investigation.

Conclusions:

• Further research is needed to address uncertainties regarding ICI's impact on female reproductive health and pregnancy in melanoma survivors.
• Oncofertility counseling and fertility preservation are crucial for women of childbearing potential undergoing ICI therapy.
• Understanding pregnancy-associated melanoma and recurrence risks is vital for optimal patient management.