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Tri-Site Academic Center Experience with Immunotherapy for Metastatic Skin Cancer in Solid Organ Transplant Patients
Hannah S Berman1, Catherine A Degesys1, Leila Tolaymat1
1From the Department of Dermatology, Mayo Clinic, Jacksonville, Florida.
Objectives:
Organ transplant recipients have an increased risk of skin cancer, but treatment options for metastatic skin cancer are limited because of their immunosuppressed state. We sought to qualify the clinical experience and patient safety of immune checkpoint inhibitors (ICIs) for skin cancer treatment in transplant recipients at one large academic institution.
Methods:
We conducted a retrospective chart review including patients who had at least one organ transplant, a diagnosis of skin cancer, and received an ICI to treat their skin cancer.
Results:
Four patients met our criteria. Three received an ICI for metastatic melanoma and died secondary to their cancer. One patient, treated for squamous cell carcinoma, had remission of his cancer with ICI treatment. Only one patient had transplant rejection.
Conclusions:
ICIs can be used in organ transplant patients, but the risk of transplant rejection must be carefully discussed because it may be associated with an increased risk of death. A higher risk of rejection exists with anti-programmed cell death 1 and anti-programmed cell death ligand 1 inhibitors.
Insights
Immune checkpoint inhibitors (ICIs) show potential for treating skin cancer in organ transplant recipients. However, their use carries risks, including potential transplant rejection and increased mortality, necessitating careful patient selection and discussion.
Area of Science:
- Oncology
- Transplant Surgery
- Immunology
Background:
- Organ transplant recipients face a higher risk of skin cancer.
- Limited treatment options exist for metastatic skin cancer in immunosuppressed transplant patients.
Purpose of the Study:
- To evaluate the clinical experience and patient safety of immune checkpoint inhibitors (ICIs) for skin cancer treatment in organ transplant recipients.
- To assess the efficacy and risks associated with ICI therapy in this vulnerable population.
Main Methods:
- Retrospective chart review of organ transplant recipients diagnosed with skin cancer and treated with ICIs.
- Inclusion criteria: history of organ transplant, skin cancer diagnosis, and ICI treatment.
Main Results:
- Four patients met the study criteria.
- Three patients with metastatic melanoma treated with ICIs died from their cancer.
- One patient with squamous cell carcinoma achieved remission with ICI treatment.
- One patient experienced transplant rejection.
Conclusions:
- Immune checkpoint inhibitors (ICIs) can be utilized in organ transplant patients for skin cancer treatment.
- Careful discussion of transplant rejection risk is crucial, as it may correlate with increased mortality.
- Anti-programmed cell death 1 and anti-programmed cell death ligand 1 inhibitors are associated with a higher risk of rejection.
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