Immune Checkpoint Inhibitors in Solid Organ Transplant Recipients With Advanced Skin Cancers-Emerging Strategies for...

Area of Science:

• Oncology
• Immunology
• Transplantation

Background:

• Solid organ transplant recipients (SOTRs) with advanced skin cancers face treatment challenges due to immunosuppression.
• Immune checkpoint inhibitors (ICIs) are effective against skin cancers but pose a risk of allograft rejection in SOTRs.

Purpose of the Study:

• To evaluate the efficacy and safety of ICIs in SOTRs with advanced skin cancers.
• To provide recommendations for managing ICIs in SOTRs, considering the risk of allograft rejection.

Main Methods:

• Review of existing literature and retrospective studies on ICI use in SOTRs.
• Analysis of response rates and allograft rejection risks associated with ICI therapy.

Main Results:

• Cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma show response to ICIs in SOTRs, albeit with lower rates than in immunocompetent patients.
• Acute allograft rejection occurs in 10% to 65% of SOTRs treated with ICIs.

Conclusions:

• ICIs can be considered for kidney transplant recipients with advanced skin cancers unresponsive to surgery or radiotherapy, prioritizing them over chemotherapy.
• Careful risk-benefit assessment, shared decision-making, and modified immunosuppression strategies (e.g., mTOR inhibitors) are essential for managing ICIs in SOTRs.