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Reproductive impact of immune checkpoint inhibitor therapy in women with melanoma
Quinn Rhodes1, Terri L Woodard2,3, Laura Detti2
1Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
Objective:
To study the reproductive impact of immune checkpoint inhibitor (ICI) therapy in cis-females with melanoma.
Design:
Retrospective cross-sectional study that examined the reproductive outcomes of female patients exposed to systemic ICI therapy.
Subjects:
Cis-female patients, aged 18-40 years, with advanced-stage melanoma and no prior sterilization procedures or exposure to other systemic antineoplastic therapies who underwent treatment with systemic ICI therapy.
Exposure:
Systemic ICI treatment as first-line, only-line therapy for advanced-stage melanoma.
Main Outcome Measures:
Menstrual cycle data, contraceptive use, antimüllerian hormone and follicle-stimulating hormone values, and reproductive outcomes (occurrence of pregnancy) during and after ICI exposure.
Results:
There were 1,755 female patients with melanoma, aged 18-40 years, evaluated at MD Anderson Cancer Center between the years of 2015 and 2022. We identified 49 cis-females who met inclusion criteria. The most common treatment regimen was nivolumab (44.9%). Among 24 patients employing nonhormonal contraception, 79.2% reported regular menstrual cycle length throughout ICI therapy, with amenorrhea attributed to pregnancy or hypophysitis observed in the minority. Eight patients had a total of nine spontaneous conceptions, with two occurring during ICI therapy and seven after therapy. Limited availability of antimüllerian hormone and follicle-stimulating hormone values precluded conclusive analysis of laboratory markers.
Conclusion:
Study findings suggest minimal short-term reproductive effects of ICI therapy, with most patients maintaining regular menstrual cycles and no occurrences of primary ovarian insufficiency observed. This study contributes reassuring insights into the short-term reproductive effects of ICI therapy, highlighting the preservation of ovarian function and menstrual regularity.
