Malignant melanoma treated with pembrolizumab during pregnancy: A case report and review of the literature

Abstract

There have been very few reports on the use of immune checkpoint inhibitors for malignant tumors during pregnancy. Herein, the current study reports a case of a patient diagnosed with advanced malignant melanoma who was treated with pembrolizumab during pregnancy. A 40-year-old primigravida underwent noninvasive prenatal testing at 10 weeks of gestation, and the result was inconclusive, suggesting the possibility of maternal malignancy. A biopsy of the gluteal mass led to a diagnosis of malignant melanoma, and computed tomography revealed extensive metastases in her lungs and lymph nodes. She had a strong desire to proceed with pregnancy. In consideration of fetal growth and maturation, monotherapy was administered with pembrolizumab from 21 weeks of gestation, aiming for 28 weeks of gestation. The fetus grew well without maternal complications. At 28 weeks of pregnancy, the patient gave birth to a healthy boy by cesarean section. There was no evidence of metastasis in the placenta. The patient received nivolumab-ipilimumab combination therapy from postpartum day 13, followed by nivolumab monotherapy, and has been alive with controlled disease for 20 months.

Melanoma During Pregnancy as a Complicated Medical Problem

“…The mother also had no adverse effects from this treatment, and no melanoma metastases were found in the placenta. The child's development after birth was normal 73 . A successful health outcome of the child of a mother with metastatic melanoma treated with ipilimumab, and low-dose aldesleukin was also observed 74 .…”

“…An individual decision by the multispecialty team and the patient after assessing possible gains and losses. There are few studies where the use of these drugs (nivolumab, pembrolizumab, ipilimumab) during pregnancy did not cause significant effects on the fetus [69][70][71][73][74][75] (in one case, IUGR and hypothyroidism were observed in the child 71 ).…”

“…68 A study on ipilimumab-treated animals (monkeys) showed a dose-dependent increase in miscarriage rates, stillbirths, preterm births, and increased infant mortality starting from the third trimester of pregnancy. 72 Anami et al 73 in their case report cited a pregnant patient treated with 3 cycles of pembrolizumab used in monotherapy. Up to 28 weeks of gestation, they observed no adverse effects in the baby such as fetal growth abnormalities or malformations.…”

A rare cause of acute airway obstruction: tracheal malignant melanoma

“…Programmed death-1 checkpoint (PD-1) inhibitors such as Pembrolizumab are also used in the treatment of malignant melanoma. Furthermore, in the literature we found information about using Pembrolizumab as a medical treatment choice which may be used during pregnancy [9].…”

Case report: Reproductive organ preservation and subsequent pregnancy for an infertility patient with lynch syndrome-associated synchronous endometrial cancer and colon cancer after treatment with a PD-1 checkpoint inhibitor

“…How PD-1 antibodies influence pregnancy has always been a topic of interest. Recently, several cases have reported successful pregnancy outcomes in patients treated with PD-1 antibodies in different cancer types, including metastatic melanoma, relapsed Hodgkin’s lymphoma and placental site trophoblastic tumors ( 6 , 7 , 19 – 27 ). Nevertheless, irAEs, such as intrauterine growth restriction, HELLP syndrome, placental insufficiency and low fetal heart rate, have occurred in some of these patients ( 28 ).…”