Treatment of metastatic cutaneous squamous cell carcinoma in a solid organ transplant recipient with programmed death-1 checkpoint inhibitor therapy
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Updated: Oct 11, 2025
Intramucosal Inoculation of Squamous Cell Carcinoma Cells in Mice for Tumor Immune Profiling and Treatment Response Assessment
Published on: April 22, 2019
K A O'Connell1,2, C D Schmults1
1Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Abstract:
Limited data exist on the use of immune checkpoint inhibitors (ICI) for the treatment of metastatic cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTR). We report a case of a SOTR who developed metastatic disease following multiple surgeries, three cycles of adjuvant radiotherapy, and minimization of immunosuppression. He was subsequently treated with pembrolizumab and achieved a complete response. However, the patient developed ICI-induced allograft rejection requiring therapy discontinuation. The allograft was salvaged following IVIg and steroids. The patient developed recurrent disease which failed rechallenge with pembrolizumab but achieved a partial response following cemiplimab administration. This case illustrates the potential to treat metastatic CSCC in a SOTR with anti-programmed death-1 therapy and preserve graft function despite allograft rejection.
Insights
Immune checkpoint inhibitors show promise for treating metastatic cutaneous squamous cell carcinoma in solid organ transplant recipients. Careful management is needed to address potential allograft rejection during treatment.
Area of Science:
- Oncology
- Immunology
- Transplantation
Background:
- Metastatic cutaneous squamous cell carcinoma (CSCC) presents unique challenges in solid organ transplant recipients (SOTR).
- Limited data exist on using immune checkpoint inhibitors (ICI) for metastatic CSCC in SOTR.
Observation:
- A SOTR with metastatic CSCC developed the disease after surgery, radiotherapy, and reduced immunosuppression.
- The patient initially responded to pembrolizumab but experienced ICI-induced allograft rejection.
Findings:
- The allograft was successfully salvaged using IVIg and steroids.
- Recurrent disease after pembrolizumab rechallenge responded to cemiplimab, achieving a partial response.
Implications:
- This case highlights the potential efficacy of anti-programmed death-1 therapy for metastatic CSCC in SOTR.
- Preserving graft function is possible despite ICI-induced allograft rejection, necessitating tailored treatment strategies.
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