Reproductive impact of immune checkpoint inhibitor therapy in women with melanoma.

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.