There was a big press release this month that announced new Canadian approval for adjuvant treatment in stage 3 patients – Tafinlar (dabrafenib) plus Mekinist (trametinib) for melanoma patients (with the BRAF V600 mutation).
THIS IS A BIG DEAL.
Prior to this month, the only options were wait and watch, interferon or clinical trial.
For myself, because I have already received adjuvant therapy in the form of interferon, and because my melanoma has not recurred, I do not qualify for treatment, but I am grateful there is progress in this field! Big changes.
As I approach my 5 year NED mark, being in my early 30’s I start to think more about pregnancy.
When I was first diagnosed my first oncologist would not broach the topic of fertility preservation with me because my prognosis was so poor. I promptly selected a new oncologist who I felt had a more patient centered care approach.
Everything I have done up until this point has been thinking about future fertility. I decided on interferon because of the limited successful pregnancies I read about post-treatment. There wasn’t enough data for me to feel comfortable choosing ipimilumab at that point (this decision was in 2014). I have also requested only MRI scans, and declined CT scans because of the risk of accumulative radiation.
I have begun reading recent studies about the effects of pregnancy on melanoma. There are odd case reports of poor outcomes, but recent meta-analyses suggest pregnancy does not worsen melanoma outcomes.
Generally, oncologists recommend waiting 2-3 years, in case of recurrence. Ribero et al. (2016) discuss the discrepancy in pregnancy counselling post-melanoma and a lack of consensus regarding recommendations. However, now more than ever, the landscape of melanoma is one of optimism with more successful treatments available than ever before.
This decision is not a light one, and making sure my partner is well informed of the risks is really important to me. The thought of starting a family is really exciting to me at this point in my life, and I feel ready.
This post is a little bit about justifying my decision making around trying to become pregnant, it is not a light one! At the end of the day life is short and risky for all of us, and I cringe at people thinking my decision is one of selfishness. Hoping this can add to the limited body of posts on the internet for young females with melanoma thinking about pregnancy.
Ribero, S., Longo, C., Dika, E., Fortes, C., Pasquali, S., Nagore, E., . . . Bataille, V. (2016). Pregnancy and melanoma: A European-wide survey to assess current management and a critical literature overview. Journal of the European Academy of Dermatology and Venereology,31(1), 65-69. doi:10.1111/jdv.13722