Value of cemiplimab in progressive metastatic cutaneous squamous cell carcinoma after kidney transplantation: a case report

Abstract

Cutaneous squamous cell carcinoma (CSCC) is the most frequent post‐transplant tumour entity resulting from immunosuppression treatment that is needed to prevent organ rejection. Solid organ transplant (SOT) recipients are at higher risk for CSCC and vulnerable for aggressive disease or a fatal course. Here, we report on a case of post‐kidney transplant metastatic CSCC, demonstrating efficacy of cemiplimab in achieving complete remission after previous disease progression under cetuximab treatment. Unfortunately, the patient developed severe pneumonia, which was only later diagnosed as cemiplimab‐associated pneumonitis. Due to a rapidly evolving septic condition, intensive care treatment was required and resulted in a fatal outcome. The patient's transplant remained intact, yet first‐line treatment of advanced CSCC, such as with cemiplimab, should be weighed critically in SOT recipients, as transplant rejection may occur. However, the present case underlines the feasibility of cemiplimab as a second‐line treatment option in this patient collective.

Cemiplimab for advanced cutaneous squamous cell carcinoma in kidney transplant recipients

“…Well known side effects of immune checkpoint inhibitors are the development of immune related adverse events. In the case series of Tsung et al, 2 of the 7 SOTR developed irAE and one case study showed severe life-threating pneumonitis after cemiplimab treatment for advanced cSCC (14,25). In our patient cohort only one patient developed low-grade skin toxicity without the need to withhold cemiplimab, with an ongoing tumor response to cemiplimab.…”

Immune Checkpoint Inhibitors in Solid Organ Transplant Recipients With Advanced Skin Cancers—Emerging Strategies for Clinical Management

“…However, EGFR inhibitors are not approved for cSCC 1 and evidence for their use is limited. 18 Most studies show poor durability of response for both chemotherapy and EGFR inhibitors in metastatic cSCC. 19,20 In melanoma, ICI is established as the first-line systemic treatment in adjuvant and metastatic settings in the ICP, with the alternative option of BRAF -/MEKtargeted inhibition in patients with melanomas that harbor a BRAF V600E mutation.…”

“…Immunological risk is dependent on transplanted organ, time since transplantation, recipient age, a history of rejection, the presence of donor-specific antibodies, and HLA-matching at time of transplantation. 18,89…”

“…However, EGFR inhibitors are not approved for cSCC 1 and evidence for their use is limited. 18 Most studies show poor durability of response for both chemotherapy and EGFR inhibitors in metastatic cSCC. 19,20…”