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Immunosuppressive Medications and Squamous Cell Skin Carcinoma: Nested Case-Control Study Within the Skin Cancer

A E Coghill1, L G Johnson2, D Berg3

  • 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|January 30, 2016
PubMed

Insights

Organ transplant recipients on azathioprine face higher squamous cell skin carcinoma risk. Newer immunosuppressants like mycophenolic acid (MPA) show a protective effect, reducing SCSC risk in transplant patients.

Area of Science:

  • Immunology
  • Dermatology
  • Transplantation Medicine

Background:

  • Organ transplant recipients (OTRs) have a significantly increased risk of squamous cell skin carcinoma (SCSC).
  • This elevated risk is primarily linked to immunosuppressive medications essential for preventing graft rejection.
  • Limited data exist on the SCSC risk associated with newer immunosuppressive drugs.

Purpose of the Study:

  • To investigate the association between specific immunosuppressive medications and SCSC risk in cardiac and renal transplant recipients.
  • To compare the SCSC risk associated with older antimetabolites (azathioprine) versus newer ones (mycophenolic acid [MPA]).
  • To evaluate the role of tacrolimus in conjunction with MPA in SCSC risk.

Main Methods:

  • The SCOT cohort study utilized a case-control design with 170 SCSC incident cases and 324 matched controls.
  • Cases were identified via medical record review following self-reported skin biopsies.
  • Conditional logistic regression analysis was employed to assess the association between specific immunosuppressive drugs and SCSC risk.

Main Results:

  • Azathioprine use was associated with more than double the risk of SCSC (OR = 2.67, 95% CI 1.23-5.76).
  • Mycophenolic acid (MPA) demonstrated a reduced risk of SCSC (OR = 0.45, 95% CI 0.29-0.69).
  • The protective association of MPA against SCSC persisted even when not used concurrently with azathioprine and after adjusting for tacrolimus (OR = 0.52, 95% CI 0.32-0.84).

Conclusions:

  • The increased SCSC risk historically linked to azathioprine is not observed with newer immunosuppressive regimens.
  • Mycophenolic acid (MPA) and tacrolimus-containing regimens appear to be associated with a lower risk of SCSC in organ transplant recipients.
  • These findings suggest a potential shift in SCSC risk profiles with evolving immunosuppression strategies post-transplantation.
Keywords:
cancer, malignancy, neoplasiaclinical research, practiceimmunosuppression, immune modulationskin, nonmelanoma, epidemiology

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