Case ReportSuccessful Pregnancy and Cancer Outcomes With Ipilimumab and Nivolumab for Metastatic Renal Cell Carcinoma: Case Report and Review of the LiteratureZambrana, Francisco MD*,†; Barbancho, Carmen MD*,‡; Huelves, Miriam MD*,§; García de Santiago, Belén PharmD, PhD*,∥; Martín, Yolanda RN*,†; Muñoz de Lengaria, Marta MD*,¶; de Velasco, Guillermo MD, PhD# Author Information *Infanta Sofía University Hospital #Doce de Octubre University Hospital, Madrid, Spain Departments of †Medical Oncology ‡Gynaecology and Obstetrics §Radiology ¶Pathology ∥Pharmacy, Madrid, Spain Reprints: Francisco Zambrana, Department of Medical Oncology, Hospital Universitario Infanta Sofía, Paseo de Europa 34, Madrid 28702, Spain (e-mail: [email protected]). Journal of Immunotherapy: November 4, 2022 - Volume - Issue - 10.1097/CJI.0000000000000448 doi: 10.1097/CJI.0000000000000448 Buy PAP Metrics Abstract Pregnancy and cancer share CTLA-4 and PD-1/PD-L1 as some of the immunomodulatory pathways that reshape the immune system from a destructive response to a state of tolerance to the fetus and the tumor, respectively. Ipilimumab (anti-CTLA-4 inhibitor) and nivolumab (anti-PD-1 inhibitor) are used in combination for the treatment of metastatic renal cell carcinoma, and their use could theoretically result in an immune response against the fetus. Furthermore, these immune checkpoint inhibitors are immunoglobulin G antibodies that transfer from the mother to the fetus and may cause a direct toxicity. We present the first report of a metastatic renal cell carcinoma patient in which ipilimumab and nivolumab were successfully used starting in her first trimester of pregnancy, with sufficient follow-up to show favorable outcomes for both the mother and the child. We describe our management of this challenging case and we review the available evidence, coming from Developmental and Reproductive Toxicology Studies and case reports of metastatic melanoma patients. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.