Gonadotoxicity of immunotherapy and targeted agents in patients with cancer and impact on subsequent pregnancies

In recent years, cancer treatment has been revolutionized by the introduction of many novel drugs, including immunotherapy and targeted agents, which have significantly improved the prognosis of patients with different solid tumors. While the role of traditional cytotoxic agents on fertility and reproductive health of patients with cancer is currently well established, the impact of novel treatments remains an unmet medical need and a subject of concern. Limited clinical evidence exists to date on the potential gonadotoxicity of targeted agents and immunotherapy. However, in preclinical male and female animal models, several new treatments have demonstrated the potential to affect reproductive capacity. Hence, the possible impact of these treatments on patients' reproductive potential should be urgently addressed. This work aims to review the most recent evidence regarding the gonadotoxicity of immunotherapy and novel targeted agents from the mechanisms of action of these treatments to the preclinical and clinical available data, as well as the implications on chances and risks of subsequent pregnancies. The final aim is to provide a useful tool to both physicians and patients for an informed decision-making process regarding fertility preservation and family planning before and after exposure to the new anticancer treatments.