Onset of azoospermia in man treated with ipilimumab/nivolumab for BRAF negative metastatic melanoma

Abstract

Azoospermia is classified as the complete absence of sperm in ejaculate and accounts for 10–15% of male infertility. Many anticancer drugs are known to cause defects in spermatogenesis, but the effects of immune checkpoint inhibitor cancer therapy on spermatogenesis remains largely unknown. Presented here is a normozoospermic man (60 million sperm/cc of ejaculate) who received a trial combination treatment of Ipilimumab/Nivolumab to treat BRAF negative, stage IV metastatic melanoma. Two years after the treatment, the patient presented as completely azoospermic. The patient subsequently underwent microdissection testicular sperm extraction, during which no sperm was retrieved, and sertoli-only pathology was elucidated.

Checkpoint inhibitors, fertility, pregnancy, and sexual life: a systematic review

“…In another case report, a normozoospermic man treated with anti-PD1 and anti-CTLA4 developed azoospermia 2 years after the immunotherapy. 23 …”

“…In another case report, a normozoospermic man treated with anti-PD1 and anti-CTLA4 developed azoospermia 2 years after the immunotherapy. 23 In a recent case series, Scovell et al 24 retrospectively analyzed testicular histology of patients treated with anti-PD1 and anti-CTLA4 that underwent autopsy. An agematched control cohort not treated with immunotherapy was used.…”

A multidisciplinary pediatric oncofertility team improves fertility preservation and counseling across 7 years

“…Furthermore, to ensure that FP outcomes are equitably obtained by all patients, it would be intriguing in a future study to consider outcomes stratified by race and ethnicity 36 . Finally, as novel treatments such as targeted therapies and immunotherapy are integrated into standard care, their impact on fertility needs to be studied to enable appropriate FP counseling of patients receiving these treatments 37–39 …”

“…36 Finally, as novel treatments such as targeted therapies and immunotherapy are integrated into standard care, their impact on fertility needs to be studied to enable appropriate FP counseling of patients receiving these treatments. [37][38][39] In summary, we implemented a multi-disciplinary pediatric oncofertility team and developed counseling and referral algorithms with improvement in FP counseling and referral across an extended period of time. While there remains opportunity for continued improvement, our framework can be utilized by other centers.…”

“… 36 Finally, as novel treatments such as targeted therapies and immunotherapy are integrated into standard care, their impact on fertility needs to be studied to enable appropriate FP counseling of patients receiving these treatments. 37 , 38 , 39 …”