Winship Amy L, Alesi Lauren R, Sant Sneha, Stringer Jessica M, Cantavenera Aldana, Hegarty Teharn, Requesens Carolina Lliberos, Liew Seng H, Sarma Urooza, Griffiths Meaghan J, Zerafa Nadeen, Fox Stephen B, Brown Emmaline, Caramia Franco, Zareie Pirooz, La Gruta Nicole L, Phillips Kelly-Anne, Strasser Andreas, Loi Sherene, Hutt Karla J
Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.
Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia.
Nat Cancer. 2022 Aug;3(8):1-13. doi: 10.1038/s43018-022-00413-x. Epub 2022 Aug 25.
Loss of fertility is a major concern for female reproductive-age cancer survivors, since a common side-effect of conventional cytotoxic cancer therapies is permanent damage to the ovary. While immunotherapies are increasingly becoming a standard of care for many cancers-including in the curative setting-their impacts on ovarian function and fertility are unknown. We evaluated the effect of immune checkpoint inhibitors blocking programmed cell death protein ligand 1 and cytotoxic T lymphocyte-associated antigen 4 on the ovary using tumor-bearing and tumor-free mouse models. We find that immune checkpoint inhibition increases immune cell infiltration and tumor necrosis factor-α expression within the ovary, diminishes the ovarian follicular reserve and impairs the ability of oocytes to mature and ovulate. These data demonstrate that immune checkpoint inhibitors have the potential to impair both immediate and future fertility, and studies in women should be prioritized. Additionally, fertility preservation should be strongly considered for women receiving these immunotherapies, and preventative strategies should be investigated in future studies.
生育能力丧失是处于生育年龄的女性癌症幸存者主要担忧的问题,因为传统细胞毒性癌症疗法的一个常见副作用是对卵巢造成永久性损害。虽然免疫疗法正日益成为许多癌症(包括治愈性治疗)的标准治疗方法,但其对卵巢功能和生育能力的影响尚不清楚。我们使用荷瘤和无瘤小鼠模型评估了阻断程序性细胞死亡蛋白配体1和细胞毒性T淋巴细胞相关抗原4的免疫检查点抑制剂对卵巢的影响。我们发现,免疫检查点抑制会增加卵巢内免疫细胞浸润和肿瘤坏死因子-α表达,减少卵巢卵泡储备,并损害卵母细胞成熟和排卵的能力。这些数据表明,免疫检查点抑制剂有可能损害即时和未来的生育能力,应优先开展针对女性的研究。此外,对于接受这些免疫疗法的女性,应强烈考虑生育力保存,并且在未来研究中应探索预防策略。