Advanced stage melanoma during pregnancy: recommendations from a retrospective, multicentre, registry-based study.

BACKGROUND: Diagnosis and treatment of advanced melanoma during pregnancy represents a major challenge, with scarce data on outcome or management available. Therefore, the Melanoma Pregnancy Taskforce collected real-world data to understand the current management approaches. METHODS: This retrospective, multicenter database included patients who were either diagnosed with advanced melanoma (newly diagnosed or recurrent) during pregnancy (group 1) or conceived while on systemic treatment (group 2) between 01/01/2011 and 07/31/2024. Information regarding patient, primary tumor and advanced melanoma characteristics, intervention or treatment during pregnancy, and outcomes of mother and fetus were collected using a standardized, de-identified form. FINDINGS: 72 women from seven countries were identified. In group 1 (n = 63), nine pregnancies were terminated, and two miscarried. Median gestational age of live births was 34 weeks (IQR 32-37). Nine patients initiated systemic treatment during pregnancy; 56 (85%) of 66 switched or initiated new treatment after delivery. 5-year overall survival was 53% (95% CI 39-71), with median follow-up of 27 months (IQR 1.0-4.8 years). In group 2 (n = 10), four pregnancies were terminated, one miscarried. Of the six live births, median gestational age was 33 weeks (IQR 32-NR). Seven (63%) of nine initiated new or continued treatment after delivery. 5-year overall survival was 71% (95% CI 51-100), with median follow-up of 42 months (IQR 2.5-4.5 years). One neonate born at 26 weeks died after three days and one had a fatal congenital malformation. One child with third trimester vemurafenib-exposure had cardiac malformations, and two neonates experienced toxicity after in utero immunotherapy exposure. No children developed melanoma, despite five placentas with melanoma involvement. INTERPRETATION: Here, we present the data from the largest contemporary dataset of outcomes of women diagnosed with advanced stage melanoma during pregnancy and provide recommendations for the diagnosis and management of advanced melanoma during pregnancy. FUNDING: Not applicable.

Duke Scholars

Author April Kelly Scott Salama Medicine, Medical Oncology