Managing melanoma during pregnancy poses significant challenges due to the need to consider both maternal and fetal health. At the 2024 American Society of Clinical Oncology (ASCO) annual meeting, two posters presented real-world data focusing on the management of cutaneous and advanced-stage melanoma during pregnancy, along with associated outcomes.
The Management of Cutaneous Melanoma for Pregnant Patients
Study Overview: Ashley Hickman et al. presented the poster titled, “Cutaneous melanoma during pregnancy: Management and real-world outcomes,” which aimed to address the incidence rates and management approaches for melanoma diagnosed during pregnancy.
Key Findings:
Incidence and Patient Characteristics: The study utilized data from the Mayo Clinic spanning from 1987 to 2023, identifying 25 pregnant patients initially. After exclusions, 19 patients were included. On average, melanoma was diagnosed at 30 years of age and at a fetal age of 20 weeks.
Treatment Approaches: During pregnancy, 82% of patients with stage I-III melanoma underwent wide local excision. However, 35% delayed sampling of sentinel lymph nodes until after delivery. Postpartum, 3 patients with stage II or III disease received adjuvant therapy with sargramostim or interferon. Notably, one patient with stage IV disease received vemurafenib monotherapy post MRI PET scan.
Maternal Outcomes: Despite delays in imaging or treatment for 60% of patients, all pregnancies resulted in term deliveries. Subsequently, 37% of patients had another pregnancy, with one experiencing melanoma recurrence (stage II followed by stage IV).
Conclusion: The authors concluded that melanoma diagnosed during pregnancy can be effectively managed with procedures like sentinel lymph node surgery and imaging without necessitating early induction of labor, highlighting the need for standardized management guidelines.
Pregnant Patients With Advanced Stage Melanoma
Study Overview: Jessica SW Borgers et al. presented the poster titled, “Advanced stage melanoma during pregnancy: Real-world management,” focusing on the management of advanced-stage melanoma and systemic treatments during pregnancy.
Key Findings:
Patient Cohort: The study collected data from January 2011 to June 2023, including 68 patients across 7 countries. Patients were predominantly diagnosed with cutaneous melanoma (76%), with 50% in stage IV and 48% in stage III.
Treatment during Pregnancy: In group 1 (patients diagnosed during pregnancy), 38% received their diagnosis in the first trimester. 8 patients received systemic treatment, predominantly targeted therapy (63%) or immunotherapy (37%). Post-pregnancy, 90% of patients initiated new systemic therapies.
Maternal and Fetal Outcomes: Group 1 had a 5-year overall survival rate of 49%. There were 50 live births, 68% of which were induced, and 56% were preterm. No children developed melanoma.
Group 2 (patients on systemic therapy when conceiving): Cutaneous melanoma was diagnosed in 82%, with 91% having a BRAF mutation. 42% received systemic treatment during pregnancy. Post-pregnancy, 50% continued or initiated new treatments, with a 5-year survival rate of 78%.
Conclusion: The study provided a comprehensive dataset on managing advanced melanoma during pregnancy and highlighted the need for developing clinical guidelines tailored to this challenging patient population.
These posters underscore the complexities and evolving strategies in managing melanoma during pregnancy, emphasizing the importance of individualized treatment approaches that prioritize both maternal oncologic outcomes and fetal health.
