Advanced stage melanoma during pregnancy: recommendations from a retrospective, multicentre, registry-based study

Area of Science:

• Oncology
• Maternal-Fetal Medicine
• Dermatology

Background:

• Advanced melanoma diagnosis and treatment during pregnancy present significant clinical challenges.
• Limited real-world data exists on the outcomes and management of pregnant patients with advanced melanoma.
• The Melanoma Pregnancy Taskforce initiated this study to address the data gap.

Purpose of the Study:

• To analyze outcomes for women diagnosed with advanced melanoma during pregnancy.
• To evaluate outcomes for women who conceived while undergoing systemic treatment for melanoma.
• To provide evidence-based recommendations for managing advanced melanoma in pregnant patients.

Main Methods:

• A retrospective, multicenter database was compiled from 2011 to 2024.
• Patients were categorized into two groups: diagnosed during pregnancy (Group 1) or conceived on systemic treatment (Group 2).
• Data collected included patient demographics, tumor characteristics, treatments during pregnancy, and maternal-fetal outcomes.

Main Results:

• 72 women were included. In Group 1 (n=63), 5-year overall survival was 53%; 85% initiated/switched treatment post-delivery. Median gestational age at live birth was 34 weeks.
• In Group 2 (n=10), 5-year overall survival was 71%; 63% initiated/continued treatment post-delivery. Median gestational age at live birth was 33 weeks.
• Adverse fetal outcomes included preterm births, one neonatal death, and congenital malformations in neonates exposed to vemurafenib or immunotherapy in utero. No children developed melanoma.

Conclusions:

• This study provides the largest contemporary dataset on advanced melanoma outcomes in pregnancy.
• Management strategies should consider maternal survival and potential fetal risks associated with treatments.
• Recommendations for diagnosis and management are proposed based on these findings.