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Intramucosal Inoculation of Squamous Cell Carcinoma Cells in Mice for Tumor Immune Profiling and Treatment Response Assessment
Published on: April 22, 2019
Systematic review of programmed cell death-1 inhibitor therapy for advanced-stage cutaneous squamous cell carcinoma
Hannah L Hanania1, Daniel J Lewis2
1Baylor College of Medicine, School of Medicine, Houston, TX, USA.
Background:
Programmed cell death-1 (PD-1) inhibitors represent an effective treatment option for advanced cutaneous squamous cell carcinoma (cSCC). However, solid organ transplant (SOT) recipients with cSCC have traditionally been excluded from clinical trials.
Objective:
To assess the safety and efficacy of PD-1 inhibitors for stage III-IV cSCC in SOT recipients.
Materials & Methods:
A systematic review was performed using the PubMed, EMBASE, and Scopus databases.
Results:
We identified 21 articles describing 33 SOT recipients (26 kidney, four liver, two lung, and one heart) with stage III-IV cSCC treated with PD-1 inhibitors. Eleven patients (33.3%) experienced allograft rejection. Of the 25 cases with iRECIST scores, twelve patients (48.0%) had a complete response (CR), eight (32.0%) showed a partial response (PR), three (12.0%) progressive disease, and two (8.0%) stable disease (SD). Including patients without available iRECIST scores, 21 patients (63.6%) showed tumor response. Eleven patients died, with six (54.5%) due to tumor progression and one (9.1%) due to allograft rejection after foregoing dialysis.
Conclusion:
PD-1 inhibitors demonstrate efficacy for advanced cSCC and confer a risk of allograft rejection in SOT recipients, requiring careful assessment of risks and benefits. If anti-PD-1 therapy is pursued, use of mTOR inhibitors, prophylactic steroids, and donor-derived cell-free DNA monitoring may mitigate the risk of rejection.
Insights
Programmed cell death-1 (PD-1) inhibitors show efficacy in advanced cutaneous squamous cell carcinoma (cSCC) for solid organ transplant (SOT) recipients. However, PD-1 inhibitor use carries a risk of allograft rejection, necessitating careful risk-benefit evaluation.
Area of Science:
- Oncology
- Immunology
- Transplantation Medicine
Background:
- Advanced cutaneous squamous cell carcinoma (cSCC) is treatable with Programmed cell death-1 (PD-1) inhibitors.
- Solid organ transplant (SOT) recipients with cSCC have historically been excluded from clinical trials.
- Assessing PD-1 inhibitor safety and efficacy in SOT recipients with advanced cSCC is crucial.
Conclusions:
- PD-1 inhibitors are effective for advanced cSCC in SOT recipients but pose a risk of allograft rejection.
- Careful risk-benefit assessment is essential before initiating PD-1 inhibitor therapy.
- Strategies like mTOR inhibitors, prophylactic steroids, and cell-free DNA monitoring may mitigate rejection risk.
