Targeted Cancer Therapy and Fertility: The Impact of Immunotherapy and Small Molecule Inhibitors on the Female Reproductive System

ABSTRACT Targeted cancer therapy is rapidly evolving the landscape of personalized health care. Novel approaches to selectively impeding tumor growth carry significant potential to improve survival outcomes, particularly for reproductive-aged patients harboring treatment refractory disease. Current agents fall within two classes, immunotherapy and small molecule inhibitors, which are collectively divided into the following subclasses: monoclonal antibodies, immunomodulators, adoptive cell therapy, treatment vaccines, kinase inhibitors, proteosome inhibitors, metalloproteinase and heat shock protein inhibitors, and promoters of apoptosis. The short- and long-term effects of these therapies on the female reproductive system are not well understood. As a result, clinicians are rendered unable to appropriately counsel women on downstream effects to their fertility. Data-driven consensus recommendations are desperately needed. This review aims to characterize the impact of targeted cancer therapy on the female hypothalamic-pituitary-ovary axis, direct ovarian function, and conception.