Clinical outcomes of solid organ transplant recipients with metastatic cancers who are treated with immune checkpoint inhibitors: A single‐center analysis

Owoyemi, Itunu; Vaughan, Lisa E.; Costello, Collin M.; Markovic, Svetomir N.; Herrmann, Joerg; Otley, Clark C.; Taner, Timuçin; Mangold, Aaron R.; Leung, Nelson; Herrmann, Sandra M.; Kukla, Aleksandra

doi:10.1002/cncr.33134

Cited by 24 publications

(17 citation statements)

References 20 publications

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“…58 Relatively high risk of rejection with anti-PD-1 was also shown in other reports, [58][59][60][61][62][63][64][65][66] and rates by organ type for this class are shown in Table 3. Renal transplant was the most common allograft type, with rejection rates of 42%-63% with anti-PD-1-based therapy [58][59][60][61][62][63][64][65] and a median time to rejection of 21-24 days from ICI start. 59,61 Underscoring the potentially life-threatening consequences of anti-PD-1 use around transplant, a recent report detailed a case of an HCC patient who underwent liver transplant after 2 years of nivolumab treatment (last dose 8 days before transplantation) and subsequently suffered fatal acute hepatic necrosis in the immediate post-operative period resulting from a profound immune reaction likely enabled by nivolumab.…”

Section: Immunodeficiency Including Transplant Recipientssupporting

confidence: 74%

“…58 The highest rejection risk was observed with PD-1 inhibitors [48% (20/ 42) overall; 54% (13/24) nivolumab, 39% (7/18) pembrolizumab], and the lowest with ipilimumab [23% (3/ 13)]. 58 Relatively high risk of rejection with anti-PD-1 was also shown in other reports, [58][59][60][61][62][63][64][65][66] and rates by organ type for this class are shown in Table 3. Renal transplant was the most common allograft type, with rejection rates of 42%-63% with anti-PD-1-based therapy [58][59][60][61][62][63][64][65] and a median time to rejection of 21-24 days from ICI start.…”

Section: Immunodeficiency Including Transplant Recipientsmentioning

confidence: 59%

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Immunotherapy use outside clinical trial populations: never say never?

et al. 2021

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Background: Based on favourable outcomes in clinical trials, immune checkpoint inhibitors (ICIs), most notably programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibitors, are now widely used across multiple cancer types. However, due to their strict inclusion and exclusion criteria, clinical studies often do not address challenges presented by non-trial populations. Design: This review summarises available data on the efficacy and safety of ICIs in trial-ineligible patients, including those with autoimmune disease, chronic viral infections, organ transplants, organ dysfunction, poor performance status, and brain metastases, as well as the elderly, children, and those who are pregnant. In addition, we review data concerning other real-world challenges with ICIs, including timing of therapy switch, relationships to radiotherapy or surgery, re-treatment after an immune-related toxicity, vaccinations in patients on ICIs, and current experience around ICI and coronavirus disease-19. Where possible, we provide recommendations to aid the oftendifficult decision-making process in those settings. Conclusions: Data suggest that ICIs are often active and have an acceptable safety profile in the populations described above, with the exception of PD-1 inhibitors in solid organ transplant recipients. Decisions about whether to treat with ICIs should be personalised and require multidisciplinary input and careful counselling of patients with respect to potential risks and benefits. Clinical judgements need to be carefully weighed, considering factors such as underlying cancer type, feasibility of alternative treatment options, or activity in trial-eligible patients.

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Section: Immunodeficiency Including Transplant Recipientssupporting

confidence: 74%

Section: Immunodeficiency Including Transplant Recipientsmentioning

confidence: 59%

Immunotherapy use outside clinical trial populations: never say never?

et al. 2021

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“… 32 , 33 Factors associated with a lower risk of rejection include the use of mammalian target of rapamycin inhibitors and triple (as opposed to dual) agent immunosuppression. 32 , 34 However, other important factors include transplant duration, history of donor-specific antibodies, or prior history of rejection. More studies are needed to determine how best to use these new cancer agents to improve outcomes in transplant recipients.…”

Section: Diagnosismentioning

confidence: 99%

Immune Checkpoint Inhibitors and Kidney Toxicity: Advances in Diagnosis and Management

2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Based on the inclusion and exclusion criteria described above, a total of 28 articles 10 – 37 including 27 articles in English and 1 article in Chinese that met the criteria were identified. A total of 47 patients who received ICI treatments after LT were reported in this study ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

An analysis report on the application of immune checkpoint inhibitors after liver transplantation

Xie

Dang

Sun

et al. 2022

Therapeutic Advances in Chronic Disease

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Up to now, a variety of immune checkpoint inhibitors (ICIs) have been proved to have good therapeutic effects in the treatment of hepatocellular carcinoma (HCC). However, the effects of their applications in liver transplant (LT) recipients are still unclear. In this analysis report, the clinical applications and therapeutic effects of ICIs on LT recipients with hepatic tumor recurrence or de novo carcinoma based on eight databases, including PubMed, EMBASE, Web of Science, Google Scholar, China National Knowledge Infrastructure, Wanfang Data, and CQVIP, were investigated. And the prior treatment, disease response, adverse reactions, and prognosis of patients with malignant tumors after LT and receiving ICI treatments were analyzed. After screening, a total of 28 articles with 47 recipients on the application of ICIs after LT were included. In these patients, their median age was 57 (14–71) years and the main type of tumor after LT was HCC (59.6%). The overall remission rate following ICI treatment was 29.8% (14/47) and the disease progression rate was 68.1% (32/47). Among all these patients, 31.9% (15/47) of patients had immune rejection; the median survival time was 6.5 (0.3–48) months, and the fatality rate was 61.7% (29/47). Considering that the therapeutic effect of ICIs in LT recipients with HCC recurrence or de novo carcinoma is not ideal, ICI treatment should be carefully considered for LT patients, and further research is needed.

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Clinical outcomes of solid organ transplant recipients with metastatic cancers who are treated with immune checkpoint inhibitors: A single‐center analysis

Cited by 24 publications

References 20 publications

Immunotherapy use outside clinical trial populations: never say never?

Immunotherapy use outside clinical trial populations: never say never?

Immune Checkpoint Inhibitors and Kidney Toxicity: Advances in Diagnosis and Management

An analysis report on the application of immune checkpoint inhibitors after liver transplantation

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