Female Oncofertility and Immune Checkpoint Blockade in Melanoma: Where
Are We Today?
Abstract
The incidence of melanoma among young adults has risen, yet mortality
has declined annually since the introduction of immune checkpoint
inhibitors (ICI). The utilization of peri-operative ICI has
significantly altered the treatment landscape in melanoma, with PD-1
inhibitors showing promising efficacy in improving relapse-free survival
rates in high-risk stage II-III disease. With the increasing use of ICI,
secondary concerns have emerged regarding the impact of cancer drugs on
fertility and reproductive health among child-bearing women, especially
in early-stage cancer settings. The exclusion of pregnant women from
trials contributes to limited human data and clinical uncertainties,
such as maternal and fetal toxicities related to ICI exposure during
pregnancy, as well as the value of fertility preservation prior to ICI
therapy. Additionally, uncertainty persists regarding pregnancy planning
after immunotherapy in an adjuvant setting, given the potential
detrimental effects of hormonal and immunological changes during
pregnancy on melanoma relapse. These considerations raise questions
about whether pregnancy-associated melanoma (PAM) represents a distinct
disease entity that warrants tailored management compared to
non-pregnant cases.