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TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients
Published on: April 13, 2021
Immune-checkpoint inhibitors in renal transplanted patients affected by melanoma: a systematic review
Ernesto Rossi1, Giovanni Schinzari1,2, Brigida Anna Maiorano3
1Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia.
Abstract:
Kidney transplantation leads to an increased risk of cancer. Melanoma is one of the most frequent neoplasms in kidney transplant recipients. Transplanted patients were excluded from trials with checkpoint inhibitors in melanoma. The authors performed a systematic review regarding the use of anti-PD1 and anti-CTLA4 agents in renal transplanted patients with melanoma. Thirty-four cases were included (24 progressive disease, eight partial responses and one stable disease) but no complete response were reported. Fourteen graft rejections were observed, especially with anti-PD1 agent. The median time from the start of immune-checkpoint inhibitor and rejection was 21 days. Response rate was similar between patients with rejection and patients without rejection. The benefit of immune-checkpoint inhibitors versus the risk of allograft rejection should be carefully weighted for each patient. A multidisciplinary approach should be considered to discuss the most appropriate treatment for every case, given the aggressiveness of melanoma in these subsets of patients.
Insights
Immune-checkpoint inhibitors show limited efficacy in melanoma patients with kidney transplants, causing significant graft rejection risks. Careful risk-benefit assessment and multidisciplinary consultation are crucial for managing these complex cases.
Area of Science:
- Oncology
- Nephrology
- Immunology
Background:
- Kidney transplant recipients have a higher risk of developing cancer, including melanoma.
- Patients with kidney transplants were previously excluded from clinical trials investigating checkpoint inhibitors for melanoma treatment.
- Melanoma in transplant recipients is aggressive and poses unique treatment challenges.
Purpose of the Study:
- To systematically review the efficacy and safety of anti-PD1 and anti-CTLA4 agents in renal transplant recipients with melanoma.
- To evaluate the incidence of allograft rejection associated with immune-checkpoint inhibitor therapy in this patient population.
Main Methods:
- Systematic review of published cases involving renal transplant recipients with melanoma treated with anti-PD1 or anti-CTLA4 agents.
- Inclusion of 34 cases to analyze treatment response and adverse events, particularly graft rejection.
Main Results:
- No complete responses were reported; outcomes included 24 progressive diseases, 8 partial responses, and 1 stable disease.
- Fourteen cases (approximately 41%) experienced graft rejection, predominantly with anti-PD1 agents, with a median onset of 21 days.
- Tumor response rates were comparable between patients who experienced rejection and those who did not.
Conclusions:
- Immune-checkpoint inhibitors demonstrate a concerning rate of allograft rejection in kidney transplant recipients with melanoma.
- The potential benefits of these therapies must be carefully weighed against the significant risk of graft rejection.
- A multidisciplinary approach is essential for personalized treatment decisions in this vulnerable patient group.
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