The START Center for Cancer Care.
Perinatal Associates of San Antonio, San Antonio.
Melanoma Res. 2020 Aug;30(4):423-425. doi: 10.1097/CMR.0000000000000657.
The treatment of cancer during pregnancy presents a unique challenge. Optimal treatments are often altered or even delayed to protect fetal growth and organogenesis. The landscape of cancer treatment has shifted dramatically over the past several years and treatment with checkpoint inhibitors, including anti-PD1 and anti-CTLA-4 agents has revolutionized treatment outcomes for patients across numerous tumor types. Until recently, little is known about the use of checkpoint inhibitor therapy during pregnancy; however, in animal studies, exposure to checkpoint inhibitors at the time of or after conception led to high incidences of spontaneous abortion, stillbirth, and premature delivery. In this report, we describe the successful pregnancy and clinical course of a patient diagnosed with metastatic melanoma who conceived twins while undergoing dual checkpoint blockade with ipilumumab and nivolumab. While there are case reports of patients receiving checkpoint inhibitors during pregnancy, our case is the first to describe a successful pregnancy that was conceived during treatment with combination anti-CTLA-4 and PD-1, with therapy continuing throughout pregnancy. This case adds to the growing evidence that favorable pregnancy outcomes may be possible while receiving checkpoint inhibition, which will hopefully allow for more optimal treatment of young pregnant patients with cancer.
怀孕期间的癌症治疗带来了独特的挑战。为了保护胎儿的生长和器官形成，通常会改变甚至延迟最佳治疗方案。在过去的几年中，癌症治疗领域发生了巨大的变化，检查点抑制剂（包括抗 PD-1 和抗 CTLA-4 药物）的治疗已经彻底改变了多种肿瘤类型患者的治疗结果。直到最近，人们对怀孕期间使用检查点抑制剂治疗知之甚少；然而，在动物研究中，在受孕时或受孕后接触检查点抑制剂会导致自然流产、死胎和早产的发生率很高。在本报告中，我们描述了一名转移性黑色素瘤患者成功怀孕和临床过程的情况，该患者在接受伊匹单抗和纳武单抗双重检查点阻断治疗期间怀上了双胞胎。虽然有报道称患者在怀孕期间接受了检查点抑制剂治疗，但我们的病例是首例描述在接受抗 CTLA-4 和 PD-1 联合治疗期间成功怀孕的病例，治疗在整个怀孕期间持续进行。这一病例增加了越来越多的证据表明，在接受检查点抑制治疗的同时可能会有良好的妊娠结局，这有望为患有癌症的年轻孕妇提供更优化的治疗。
