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 women of childbearing potential, 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 before ICI therapy. Uncertainty persists regarding pregnancy post-adjuvant immunotherapy, given the potential detrimental effects of hormonal and immunological changes during pregnancy on melanoma relapse. There is additional uncertainty about whether pregnancy-associated melanoma (PAM) represents a distinct disease entity that warrants tailored management compared to non-pregnant cases. Our review aims to give an overview of oncofertility practices among female melanoma patients after immunotherapy. We also focus on the literature gap in the published evidence and synthesize summaries regarding ICI toxicities on reproductive health and fetal development, pregnancy planning, and recurrence risks after melanoma treatment.
年轻成人黑色素瘤发病率有所上升，但自免疫检查点抑制剂（ICI）问世以来，其死亡率逐年下降。围手术期ICI的应用显著改变了黑色素瘤的治疗格局，其中PD-1抑制剂在改善高危II-III期疾病无复发生存率方面展现出良好疗效。随着ICI使用日益广泛，关于抗癌药物对育龄期女性生育力与生殖健康的影响——尤其在早期癌症治疗中——已成为值得关注的次要问题。由于临床试验排除孕妇群体，导致相关人体数据匮乏及临床不确定性，包括妊娠期暴露于ICI可能引发的母胎毒性，以及ICI治疗前生育力保存的价值。鉴于妊娠期激素与免疫变化可能对黑色素瘤复发产生不利影响，辅助免疫治疗后妊娠的安全性仍存疑虑。此外，妊娠相关黑色素瘤是否构成区别于非妊娠病例的独立疾病实体，从而需要个体化诊疗方案，目前亦无定论。本综述旨在概述女性黑色素瘤患者免疫治疗后的肿瘤生殖医学实践，聚焦现有证据中的文献空白，综合梳理ICI对生殖健康与胎儿发育的毒性、妊娠规划及黑色素瘤治疗后复发风险等方面的研究进展。
Female Oncofertility and Immune Checkpoint Blockade in Melanoma: Where Are We Today?
肿瘤(癌症)患者之家