Stage IV Melanoma, Checkpoint Inhibitors, and Pregnancy
Posted: Tuesday, November 20, 2018
An unusual pregnancy and birth scenario in the setting of stage IV melanoma was featured in a letter to the editor in the European Journal of Cancer. “In the case of stage IV disease, therapeutic planning should be thoroughly discussed with the patient and decided individually for each case,” the authors recommended.
In January 2017, a 34-year-old, 18-week-pregnant female…presented with vastly metastasized melanoma, noted the team headed by Jessica C. Hassel, MD, of the National Center for Tumor Diseases and the University of Heidelberg, Germany. Although the woman had previously had an alleged Spitz nevus in 2005, followed by a single subcutaneous melanoma metastasis in the same location in mid-2016, follow-ups had been unremarkable. However, pain and labored breathing led to sonograms and magnetic resonance imaging, which confirmed metastases throughout her organs.
“The patient and her husband refused an abortion but were willing to risk miscarriage by a treatment,” the team described. She had two cycles of a checkpoint inhibitor combination—ipilimumab plus nivolumab. Despite close monitoring, her condition deteriorated, and a caesarean section was necessary. The mother died a day later.
“The lack of therapeutic efficacy probably ensured the maintenance of the pregnancy,” Dr. Hassel and colleagues theorized.
Of all cancers, melanoma metastasizes to the fetus most often, in about 22% of cases. This child will receive regular liver sonograms, dermatologic examinations, and checks of S100 serum levels. Thus far, her development has been “largely unremarkable,” the authors reported.
“Because recurrence in more advanced melanoma is most likely within the period of the first 3 years after diagnosis, it is recommended to postpone pregnancy after this time frame if planning of offspring is an option,” the authors suggested.