Everolimus and Malignancy after Solid Organ Transplantation: A Clinical Update

Area of Science:

• Oncology
• Transplantation Medicine
• Immunosuppression

Background:

• Malignancy is a significant cause of mortality following solid organ transplantation.
• Mammalian target of rapamycin (mTOR) inhibitors possess antioncogenic properties and everolimus is approved for treating several cancers.
• Registry and trial data suggest mTOR inhibition may lower de novo malignancy rates in kidney transplant recipients.

Approach:

• Review of registry studies, randomized trials, case reports, and meta-analyses concerning mTOR inhibitors, specifically everolimus.
• Evaluation of everolimus's impact on de novo malignancy, post-transplant malignancy treatment, and cancer recurrence in solid organ transplant recipients.
• Assessment of evidence in kidney and heart transplantation, including specific cancers like Kaposi's sarcoma, nonmelanoma skin cancer, and hepatocellular carcinoma (HCC).

Key Points:

• Everolimus may reduce de novo malignancy rates in kidney transplant patients.
• Switching to everolimus might benefit patients with post-transplant Kaposi's sarcoma and nonmelanoma skin cancer.
• mTOR inhibition is associated with lower HCC recurrence rates compared to calcineurin inhibitors, with potential survival benefits observed in non-transplant HCC patients.

Conclusions:

• Everolimus demonstrates potential in mitigating post-transplant malignancy.
• Further prospective studies are needed to confirm the benefits of switching to everolimus for specific post-transplant malignancies.
• Everolimus represents a promising therapeutic option for reducing the burden of cancer after solid organ transplantation in select cases.