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Research Letter
June 18, 2020

Association of Impaired Spermatogenesis With the Use of Immune Checkpoint Inhibitors in Patients With Metastatic Melanoma

Author Affiliations
  • 1Scott Department of Urology, Baylor College of Medicine, Houston, Texas
  • 2Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
  • 3James Buchanan Brady Urological Institutions, The Johns Hopkins Medical Institutions, Baltimore, Maryland
  • 4Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
JAMA Oncol. Published online June 18, 2020. doi:10.1001/jamaoncol.2020.1641

The emergence of immune checkpoint inhibitors (ICIs) has provided previously unachievable curative therapy for many patients, particularly those with metastatic melanoma.1 However, the long-term outcomes for patients using ICIs are only beginning to be investigated. One important potential unexplored adverse effect is impaired male fertility. The current American Society of Clinical Oncology guidelines (July 2018) state that “sperm cryopreservation is effective, and health care providers should discuss sperm banking with postpubertal males receiving cancer treatment.”2(p1995) The direct association of ICI treatment with spermatogenesis has not been explored, to our knowledge.3 It will be critical to determine the risk to future male fertility for patients undergoing ICI therapy to accurately guide pretreatment counseling. To address the association between the potential gonadotoxic effect of ICIs and spermatogenesis, to our knowledge, we performed the first retrospective review of an index patient who became infertile after ICI therapy and subsequently died, and we performed a retrospective cohort cadaver study of patients with metastatic melanoma.

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