Pauline De Bruyn1, Dirk Van Gestel1, Piet Ost2, Vibeke Kruse3, Lieve Brochez4, Hans Van Vlierberghe5, Arnaud Devresse6, Véronique Del Marmol4, Alain Le Moine7, Sandrine Aspeslagh4,8,9,10. 1. Department of Radiation Oncology, Institut Jules Bordet - ULB, Brussels. 2. Department of Radiation Oncology. 3. Department of Medical Oncology. 4. Department of Dermatology. 5. Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent. 6. Department of Nephrology, University Hospital St-Luc - UCL. 7. Department of Nephrology, Erasme Hospital. 8. Department of Medical Oncology, Institut Jules Bordet - ULB. 9. Department of Medical Oncology, UZBrussel - VUB. 10. Department of Medical Oncology, Erasme Hospital-ULB, Brussels, Belgium.
Abstract
PURPOSE OF REVIEW: Checkpoint inhibitors (CPIs) provide impressive response rates among immunocompetent patients with various solid tumors. So far, organ transplant recipients have been excluded from clinical studies due to the putative risk of allograft rejection however 48 cases of liver and renal transplant patients treated with CPI were already described in literature. RECENT FINDINGS: Here we discuss 19 cases of liver and 29 cases of renal transplant patients who received CPI for advanced cancer. Disease control rate [stable disease, complete response (CR) and partial response (PR) together] was 35% (21% for liver and 45% for kidney transplant patients). Graft rejection was seen in 37% of liver and 45% and kidney transplant patients. Significantly, our analysis shows that an 'ideal' response occurs in 21% of all patients (antitumor response accompanied with durable graft tolerance). SUMMARY: We believe that transplant patients can be treated with CPI in a controlled setting and for well informed patients. To obtain a durable antitumor immune response while avoiding rejection, to be able to adjust immunosuppression and to have the opportunity to develop biomarkers for tumor response and transplant rejection, these patients should be treated according to a clinical care path or a prospective clinical trial.
PURPOSE OF REVIEW: Checkpoint inhibitors (CPIs) provide impressive response rates among immunocompetent patients with various solid tumors. So far, organ transplant recipients have been excluded from clinical studies due to the putative risk of allograft rejection however 48 cases of liver and renal transplantpatients treated with CPI were already described in literature. RECENT FINDINGS: Here we discuss 19 cases of liver and 29 cases of renal transplantpatients who received CPI for advanced cancer. Disease control rate [stable disease, complete response (CR) and partial response (PR) together] was 35% (21% for liver and 45% for kidney transplant patients). Graft rejection was seen in 37% of liver and 45% and kidney transplant patients. Significantly, our analysis shows that an 'ideal' response occurs in 21% of all patients (antitumor response accompanied with durable graft tolerance). SUMMARY: We believe that transplant patients can be treated with CPI in a controlled setting and for well informed patients. To obtain a durable antitumor immune response while avoiding rejection, to be able to adjust immunosuppression and to have the opportunity to develop biomarkers for tumor response and transplant rejection, these patients should be treated according to a clinical care path or a prospective clinical trial.
Authors: Evan J Lipson; Fizza F Naqvi; Manisha J Loss; Megan D Schollenberger; Drew M Pardoll; Jack Moore; Daniel C Brennan Journal: Am J Transplant Date: 2020-04-12 Impact factor: 8.086