Viable Pregnancy in a patient with metastatic melanoma treated with double checkpoint immunotherapy

Publication date: Available online 22 March 2018
Source:Seminars in Oncology
Author(s): Mauricio Burotto, Juan G. Gormaz, Suraj Samtani, Nicolas Valls, Ricardo Silva, Carlos Rojas, Sergio Portiño, Carlos de la Jara
Metastatic cancers during pregnancy have historically been associated to dismal outcomes, with greater rates of tumor progression in part due to diminished treatment alternatives. Immunotherapy with T-cell checkpoint inhibitors has significantly impacted the survival of several metastatic tumors. However, given their mechanism of action immune-related adverse events can occur, especially with combined immunotherapy treatments. During pregnancy, checkpoint pathways have a major role providing immune tolerance to the fetal allograft. Furthermore, evidence suggests that inhibition of this pathway may be associated with an increased risk of miscarriage. We describe, to our knowledge, the first case reported in the literature of a patient 7 weeks pregnant diagnosed with metastatic melanoma and treated with nivolumab plus ipilimumab. We also present the associated immune-related side effects and their treatment as well as the oncologic results that lead to favorable pregnancy outcome.



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