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Published on: September 12, 2019
Immune checkpoint inhibitors in malignancies after liver transplantation: A systematic review and pooled analysis
Stefano Kayali1, Andrea Pasta1, Maria Corina Plaz Torres1
1Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
Background And Aims:
Treatment of de novo malignancies and recurrent hepatocellular carcinoma with immune checkpoint inhibitors (ICI) in liver transplant recipients (LT) is an attractive strategy that is infrequently pursued because of the lack of strong evidence regarding their safety and efficacy. In this systematic review with pooled analysis, we aimed to assess safety and efficacy of ICI therapy following LT.
Methods:
We performed a systematic search of case reports and series published until January 2022. We included 31 publications reporting a total of 52 patients treated with ICIs after LT and assessed in a pooled analysis the risk of graft rejection and the outcome of ICI therapy.
Results:
Acute graft rejection occurred in 15 patients (28.8%) and 7 patients (13.4% of the total cohort) died because of graft loss. Rejection was associated with shorter overall survival (OS) (17.2 months, confidence interval [CI] 12.1-22.2 vs. 3.5 months, CI 1.6-5.4, p < 0.001). Disease control rate was 44.2% (n = 23), and in these patients, OS was longer than in non-responders (26.4 months, CI 20.8-32.0 vs. 3.4 months, CI 2.1-4.7, p < 0.001).
Conclusions:
Observational, off-label experience suggests that treatment with ICI for advanced malignancies in LT recipients might not be discarded a priori. This notwithstanding, ICI treatment in these patients is associated with a substantial risk of graft rejection and mortality. Prospective studies are needed to provide adequate safety and efficacy figures of ICI treatment in this fragile population.
Insights
Immune checkpoint inhibitors (ICI) show potential for treating advanced cancers in liver transplant (LT) recipients, but carry significant risks of graft rejection and mortality. Further research is crucial to determine their safety and efficacy in this population.
Area of Science:
- Oncology
- Transplantation Immunology
- Immunotherapy
Background:
- Immune checkpoint inhibitors (ICI) offer a promising strategy for de novo malignancies and recurrent hepatocellular carcinoma in liver transplant (LT) recipients.
- However, limited evidence exists regarding the safety and efficacy of ICI therapy post-LT, hindering its clinical application.
- This study systematically reviews and analyzes ICI use in LT recipients to assess associated risks and outcomes.
Approach:
- A systematic literature search was conducted for case reports and series published up to January 2022.
- Data from 31 publications involving 52 patients treated with ICI post-LT were pooled for analysis.
- The analysis focused on evaluating the risk of graft rejection and the overall efficacy of ICI therapy.
Key Points:
- Acute graft rejection occurred in 28.8% of patients, with 13.4% experiencing graft loss and mortality.
- Graft rejection was significantly associated with shorter overall survival (OS).
- A disease control rate of 44.2% was observed, with responders exhibiting longer OS compared to non-responders.
Conclusions:
- While ICI treatment for advanced malignancies in LT recipients should not be dismissed, it presents a substantial risk of graft rejection and mortality.
- Current evidence is based on observational, off-label use, highlighting the need for caution.
- Prospective studies are essential to establish definitive safety and efficacy data for ICI therapy in this vulnerable patient group.
