Pregnancy and Melanoma: Recommendations for Clinical Scenarios

Berk-Krauss, Juliana; Liebman, Tracey N.; Stein, Jennifer A.

doi:10.1016/j.ijwd.2017.11.006

Cited by 8 publications

(12 citation statements)

References 23 publications

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“…Despite immunologic changes during pregnancy that may decrease immune surveillance and the finding that some melanomas harbor sex-hormone receptors, the preponderance of evidence does not support a poorer prognosis for pregnancy-associated melanomas. 15 Ovarian stimulation was not found to induce changes in moles, and pregnancy was similarly not associated with a difference in melanoma thickness. 14,16 Fertility preservation for oocyte or embryo cryopreservation, however, does introduce a delay of 2-5 weeks to the start of anticancer therapy and may not be applicable to those who require immediate treatment.…”

Section: Discussionmentioning

confidence: 91%

Minding the Bathwater: Fertility and Reproductive Toxicity in the Age of Immuno-Oncology

Kim

Nelson

Stimpert

et al. 2022

JCO Oncology Practice

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Immune checkpoint inhibition has resulted in significant efficacy across many cancer types, including melanoma. Melanoma is the second most common cancer among those of reproductive age, yet the reproductive toxicities of adjuvant and first-line immunotherapy are largely unknown.The normal innate and adaptive immune systems play a vital role in reproductive organ homeostasis of men and women and are essential for implantation, fertility, and a successful pregnancy. The programmed cell death-1 receptor/programmed cell death receptor ligand-1 (PD-1/PD-L1) pathway is essential in several aspects of fertility and pregnancy. Recent studies have largely focused on the role of the PD-1/PD-L1 pathway in fetomaternal tolerance, highlighting the importance of intact immune regulation in promoting a successful pregnancy.In this review, we describe a case of a reproductive-aged female with stage IIIC melanoma who sought guidance on family planning after pembrolizumab therapy. We discuss the known fertility-related toxicities of immune checkpoint inhibitors, the potential targets for reproductive toxicity in males and nonpregnant females, and the implications of anti–PD-1 therapy in relation to fetomaternal tolerance. Informed decision making will benefit from data and consensus.

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Section: Discussionmentioning

confidence: 91%

Minding the Bathwater: Fertility and Reproductive Toxicity in the Age of Immuno-Oncology

Kim

Nelson

Stimpert

et al. 2022

JCO Oncology Practice

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“…Pregnancy-associated melanoma metastases were found in 30 described cases of placental metastases, whereas only 8 such cases have been reported in the literature 35,37,45,82,86 . Within the first year of life, the disease led to death in 6 of them.…”

Section: Methodsmentioning

confidence: 99%

“…82 Pregnancy-associated melanoma metastases were found in 30 cases of placental metastases, whereas only 8 such cases have been reported in the literature. 35,37,45,82,86 Within the first year of life, the disease led to death in 6 of them. It is suspected that such a small number of described patients are associated with insufficient studies, because the majority of placentas are not subjected to histopathological examination, and moreover, the observation of children of mothers with MM was too short.…”

mentioning

confidence: 99%

Melanoma During Pregnancy as a Complicated Medical Problem

Kościelecka¹,

Kubik-Machura²,

Kuć³

et al. 2023

Obstetrical &Amp; Gynecological Survey

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ImportancePregnancy-associated melanomas (PAMs)—this is how melanomas identified during the childbearing years or up to 1 year after birth have been defined, accounting for one third of women in whom it is diagnosed. The exact epidemiology of melanoma is difficult to determine. However, its incidence is undoubtedly increasing, most likely related to the increasing age of mothers.ObjectiveThe purpose of this study was to review the prognosis, diagnosis, and treatment; the effect of melanoma on pregnancy; and the effect of pregnancy on melanoma and melanocytic lesions.Evidence AcquisitionAn extensive manual search of major electronic databases was conducted in January 2022. The following literature review provides comprehensive coverage of PAMs.ResultsAny new nevus detected during pregnancy and changes in the nevus regarding color, diameter, symmetry, or lesion border require medical evaluation. New therapies for malignant melanoma, such as immunotherapy and targeted therapy, have improved overall survival and progression-free survival, but their use is often contraindicated in pregnant patients. Melanoma is considered to be the neoplasm most commonly involving the fetus and placenta.ConclusionsThere are reports where immunotherapy and targeted therapy used in the patient were not associated with serious consequences for the fetus, being a therapeutic option for the patient. The described cases of pregnancy outcome during modern melanoma treatment are extremely important and may allow to shape the optimal therapeutic regimen in pregnant women with melanoma.RelevanceEducation of pregnant women in the context of observation of skin lesions as well as maintenance of oncological vigilance by physicians seem to be an important element in limiting difficult decisions related to therapy of more advanced disease. Further large-scale studies using modern treatment in pregnant women with melanoma are needed.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter completing this activity, the learner should be better able to describe the importance of oncologic vigilance in the context of developing melanoma in a pregnant woman; discuss the need for further research on the use of immunotherapy and targeted therapy in pregnant women with melanoma; and explain the need for oncologic vigilance in the context of melanoma in children of mothers who developed melanoma during pregnancy.

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“…However, there is no clear evidence which would justify the use of aromatase inhibitors in melanoma patients. 79 , 80 …”

Section: Recommendationsmentioning

confidence: 99%

Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy

et al. 2021

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Melanoma is one of the most common cancers in adolescents and adults at fertile age, especially in women. With novel and more effective systemic therapies that began to profoundly change the dismal outcome of melanoma by prolonging overall survival, the wish for fertility preservation or even parenthood has to be considered for a growing portion of melanoma patients—from the patients' as well as from the physicians' perspective. The dual blockade of the mitogen-activated protein kinase pathway by B-Raf proto-oncogene serine/threonine kinase and mitogen-activated protein kinase inhibitors and the immune checkpoint inhibition by anti-programmed cell death protein 1 and anti-cytotoxic T-lymphocyte-associated protein-4 monoclonal antibodies constitute the current standard systemic approaches to combat locally advanced or metastatic melanoma. Here, the preclinical data and clinical evidence of these systemic therapies are reviewed in terms of their potential gonadotoxicity, teratogenicity, embryotoxicity and fetotoxicity. Recommendations for routine fertility and contraception counseling of melanoma patients at fertile age are provided in line with interdisciplinary recommendations for the diagnostic work-up of these patients and for fertility-protective measures. Differentiated recommendations for the systemic therapy in both the adjuvant and the advanced, metastatic treatment situation are given. In addition, the challenges of pregnancy during systemic melanoma therapy are discussed.

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Pregnancy and Melanoma: Recommendations for Clinical Scenarios

Cited by 8 publications

References 23 publications

Minding the Bathwater: Fertility and Reproductive Toxicity in the Age of Immuno-Oncology

Minding the Bathwater: Fertility and Reproductive Toxicity in the Age of Immuno-Oncology

Melanoma During Pregnancy as a Complicated Medical Problem

Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy

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