Itunu Owoyemi1, Lisa E Vaughan2, Collin M Costello3, Charat Thongprayoon1, Svetomir N Markovic4, Joerg Herrmann5, Clark C Otley6, Timucin Taner7,8,9, Aaron R Mangold3, Nelson Leung1, Sandra M Herrmann1, Aleksandra Kukla1,8. 1. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota. 2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. 3. Department of Dermatology, Mayo Clinic, Scottsdale, Arizona. 4. Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota. 5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 6. Department of Dermatology, Mayo Clinic, Rochester, Minnesota. 7. Department of Surgery, Mayo Clinic, Rochester, Minnesota. 8. William J. von Liebig Transplant Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota. 9. Department of Immunology, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, but to the authors' knowledge, limited data exist regarding the safety and efficacy of these agents in transplant recipients. Herein, the authors have reported their experience with 17 patients who were treated with ICIs for metastatic malignancies after undergoing solid organ transplantation. METHODS: Data were abstracted for solid organ transplant recipients who received ICIs for the treatment of malignancy between January 1, 2016, and September 30, 2019. The authors identified 7 kidney, 8 liver, and 2 heart transplant recipients. Outcomes of interest were adverse drug reactions, cancer progression, and patient survival. RESULTS: The most common malignancies treated with ICIs were metastatic squamous cell carcinoma (5 patients; 29%) and hepatocellular carcinoma (5 patients; 29%), which were noted exclusively among liver transplant recipients. The median duration on ICIs was 1.7 months (interquartile range, 0.4-7.6 months). Five patients (29%) developed adverse reactions, including 4 patients (24%) with immune-related adverse events(irAEs), 3 patients (18%) with acute allograft rejections, 1 patient (6%) with autoimmune colitis, and 1 patient (6%) with ICI-induced cardiotoxicity (the patient was a heart transplant recipient). The cumulative incidence of cancer progression was 50% and 69%, respectively, at 6 months and 12 months. Eleven patients (65%) died over the median follow-up period of 4.6 months (interquartile range, 1.5-13.2 months) from the time of ICI initiation, with cancer progression being the most common cause of death. CONCLUSIONS: ICIs can be used as individualized therapy in selected patients who have undergone solid organ transplantation but more studies are needed to determine how best to use these agents to improve outcomes further.
BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, but to the authors' knowledge, limited data exist regarding the safety and efficacy of these agents in transplant recipients. Herein, the authors have reported their experience with 17 patients who were treated with ICIs for metastatic malignancies after undergoing solid organ transplantation. METHODS: Data were abstracted for solid organ transplant recipients who received ICIs for the treatment of malignancy between January 1, 2016, and September 30, 2019. The authors identified 7 kidney, 8 liver, and 2 heart transplant recipients. Outcomes of interest were adverse drug reactions, cancer progression, and patient survival. RESULTS: The most common malignancies treated with ICIs were metastatic squamous cell carcinoma (5 patients; 29%) and hepatocellular carcinoma (5 patients; 29%), which were noted exclusively among liver transplant recipients. The median duration on ICIs was 1.7 months (interquartile range, 0.4-7.6 months). Five patients (29%) developed adverse reactions, including 4 patients (24%) with immune-related adverse events(irAEs), 3 patients (18%) with acute allograft rejections, 1 patient (6%) with autoimmune colitis, and 1 patient (6%) with ICI-induced cardiotoxicity (the patient was a heart transplant recipient). The cumulative incidence of cancer progression was 50% and 69%, respectively, at 6 months and 12 months. Eleven patients (65%) died over the median follow-up period of 4.6 months (interquartile range, 1.5-13.2 months) from the time of ICI initiation, with cancer progression being the most common cause of death. CONCLUSIONS: ICIs can be used as individualized therapy in selected patients who have undergone solid organ transplantation but more studies are needed to determine how best to use these agents to improve outcomes further.
Authors: Eric A Engels; Ruth M Pfeiffer; Joseph F Fraumeni; Bertram L Kasiske; Ajay K Israni; Jon J Snyder; Robert A Wolfe; Nathan P Goodrich; A Rana Bayakly; Christina A Clarke; Glenn Copeland; Jack L Finch; Mary Lou Fleissner; Marc T Goodman; Amy Kahn; Lori Koch; Charles F Lynch; Margaret M Madeleine; Karen Pawlish; Chandrika Rao; Melanie A Williams; David Castenson; Michael Curry; Ruth Parsons; Gregory Fant; Monica Lin Journal: JAMA Date: 2011-11-02 Impact factor: 157.335
Authors: Noha Abdel-Wahab; Houssein Safa; Ala Abudayyeh; Daniel H Johnson; Van Anh Trinh; Chrystia M Zobniw; Heather Lin; Michael K Wong; Maen Abdelrahim; A Osama Gaber; Maria E Suarez-Almazor; Adi Diab Journal: J Immunother Cancer Date: 2019-04-16 Impact factor: 13.751
Authors: Edward K Geissler; Andreas A Schnitzbauer; Carl Zülke; Philipp E Lamby; Andrea Proneth; Christophe Duvoux; Patrizia Burra; Karl-Walter Jauch; Markus Rentsch; Tom M Ganten; Jan Schmidt; Utz Settmacher; Michael Heise; Giorgio Rossi; Umberto Cillo; Norman Kneteman; René Adam; Bart van Hoek; Philippe Bachellier; Philippe Wolf; Lionel Rostaing; Wolf O Bechstein; Magnus Rizell; James Powell; Ernest Hidalgo; Jean Gugenheim; Heiner Wolters; Jens Brockmann; André Roy; Ingrid Mutzbauer; Angela Schlitt; Susanne Beckebaum; Christian Graeb; Silvio Nadalin; Umberto Valente; Victor Sánchez Turrión; Neville Jamieson; Tim Scholz; Michele Colledan; Fred Fändrich; Thomas Becker; Gunnar Söderdahl; Olivier Chazouillères; Heikki Mäkisalo; Georges-Philippe Pageaux; Rudolf Steininger; Thomas Soliman; Koert P de Jong; Jacques Pirenne; Raimund Margreiter; Johann Pratschke; Antonio D Pinna; Johann Hauss; Stefan Schreiber; Simone Strasser; Jürgen Klempnauer; Roberto I Troisi; Sherrie Bhoori; Jan Lerut; Itxarone Bilbao; Christian G Klein; Alfred Königsrainer; Darius F Mirza; Gerd Otto; Vincenzo Mazzaferro; Peter Neuhaus; Hans J Schlitt Journal: Transplantation Date: 2016-01 Impact factor: 4.939