Treatment of metastatic malignant melanoma during pregnancy with a BRAF kinase inhibitor: A case report

Pagan, Megan; Jinks, Heather; Sewell, M. F.

doi:10.1016/j.crwh.2019.e00142

Cited by 10 publications

(12 citation statements)

References 7 publications

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“…The last ESMO clinical practice guidelines mention that ipilimumab (a monoclonal antibody against CTLA4) or vemurafenib (a BRAF inhibitor) should not be used during pregnancy because of the lack of safety data, proposing an alternative to interferon-alpha [ 17 ]. Even though contradictory findings have been reported for BRAF inhibitors [ 37 , 38 , 39 , 40 ], the use of immune checkpoint inhibitors appears relatively safe based on several reports [ 41 , 42 , 43 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

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Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents

Benoit

Mir

Vialard

et al. 2021

Cancers

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The occurrence of cancer during pregnancy is observed in 1 in 1000 pregnancies and is expected to increase given the trend of delaying childbearing. While breast cancer is the most common, the incidence of other cancers, such as cervical, ovarian, and lung cancers as well as hemopathies and melanomas, is also increasing. Thus, cancer occurrence in pregnant women raises questions of management during pregnancy and, especially, assessment of the treatment benefit–risk ratio to ensure optimal management for the mother while ensuring the safety of the fetus. Chemotherapy remains a cornerstone of cancer management. If the use of anticancer agents appears possible during pregnancy, while avoiding the first trimester, the extent of placental transfer of different anticancer agents varies considerably thereafter. Furthermore, the significant physiological pharmacokinetic variations observed in pregnant women may have an impact on the placental transfer of anticancer agents. Given the complexity of predicting placental transfer of anticancer agents, preclinical studies are therefore mandatory. The aim of this review was to provide updated data on in vivo and ex vivo transplacental transfer of anticancer agents used in the management of the most common pregnancy-associated cancers to better manage these highly complex cases.

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Section: Resultsmentioning

confidence: 99%

“…In humans, data on the use of vemurafenib during pregnancy are limited to case reports [ 37 , 39 , 145 ]. No fetal or neonatal malformations have been reported, but one case described intrauterine growth restriction that required a cesarean section at 30 WG.…”

Section: Resultsmentioning

confidence: 99%

Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents

Benoit

Mir

Vialard

et al. 2021

Cancers

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“…In animal studies (rats and rabbits), vemurafenib crosses the placenta without any teratogenic effects. In the literature are reported some cases of women treated with vemurafenib during pregnancy after the first trimester for metastatic melanoma, without any maternal and fetal side effects [151]. Maleka et al describe the case of one pregnant patient with metastatic melanoma who responded immediately to vemurafenib (with the shrinkage of tumor and normalization of transaminases).…”

Section: Vemurafenibmentioning

confidence: 99%

Transplacental Passage and Fetal Effects of Antineoplastic Treatment during Pregnancy

Triarico

Rivetti

Capozza³

et al. 2022

Cancers

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The incidence of PAC is relatively infrequent among pregnant women. However, it has gradually increased in recent years, becoming a challenging area for clinicians that should take into account in the same way maternal benefits and fetal potential risks correlated to the antineoplastic treatment. None of the antineoplastic drugs is completely risk-free during the pregnancy, the timing of exposure and transplacental transfer properties influence the toxicity of the fetus. Despite the lack of guidelines about the management of PAC, several studies have described the use and the potential fetal and neonatal adverse events of antineoplastic drugs during pregnancy. We provide a review of the available literature about the transplacental passage and fetal effects of chemotherapy and targeted agents, to guide the clinicians in the most appropriate choices for the management of PAC.

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“… 56 In the few published case reports to date, no congenital malformations were described in newborns born to mothers treated with vemurafenib during pregnancy. 56 , 57 , 58 , 59 …”

Section: Recommendationsmentioning

confidence: 99%

“…Possible common side-effects of BRAF/MEK inhibition as well as of ICI include, but are not limited to, fever and gastrointestinal AEs. Only sporadic clinical evidence is available in the form of case reports, conveying favorable as well as unfavorable outcomes of ICI 62 , 69 or targeted therapy 56 , 58 , 59 in pregnant melanoma patients, for whom individual therapeutic decisions to continue or initiate melanoma therapy had to be taken due to specific, sometimes woeful circumstances. Based on the review of the literature, safety data and SmPC information, we conclude that for BRAF and MEK inhibition as well as for ICI a risk for impaired embryonal development and miscarriage exists.…”

Section: Recommendationsmentioning

confidence: 99%

Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy

et al. 2021

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Melanoma is one of the most common cancers in adolescents and adults at fertile age, especially in women. With novel and more effective systemic therapies that began to profoundly change the dismal outcome of melanoma by prolonging overall survival, the wish for fertility preservation or even parenthood has to be considered for a growing portion of melanoma patients—from the patients' as well as from the physicians' perspective. The dual blockade of the mitogen-activated protein kinase pathway by B-Raf proto-oncogene serine/threonine kinase and mitogen-activated protein kinase inhibitors and the immune checkpoint inhibition by anti-programmed cell death protein 1 and anti-cytotoxic T-lymphocyte-associated protein-4 monoclonal antibodies constitute the current standard systemic approaches to combat locally advanced or metastatic melanoma. Here, the preclinical data and clinical evidence of these systemic therapies are reviewed in terms of their potential gonadotoxicity, teratogenicity, embryotoxicity and fetotoxicity. Recommendations for routine fertility and contraception counseling of melanoma patients at fertile age are provided in line with interdisciplinary recommendations for the diagnostic work-up of these patients and for fertility-protective measures. Differentiated recommendations for the systemic therapy in both the adjuvant and the advanced, metastatic treatment situation are given. In addition, the challenges of pregnancy during systemic melanoma therapy are discussed.

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Treatment of metastatic malignant melanoma during pregnancy with a BRAF kinase inhibitor: A case report

Cited by 10 publications

References 7 publications

Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents

Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents

Transplacental Passage and Fetal Effects of Antineoplastic Treatment during Pregnancy

Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy

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