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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 22 août 2019
Doi : 10.1016/j.jaad.2019.07.005
accepted : 3 July 2019
Immune checkpoint inhibitor therapy in solid organ transplant recipients: A patient-centered systematic review
 

Juliya Fisher, MD a, Nathalie Zeitouni, MDCM, FRCPC b, Weijia Fan, MS c, Faramarz H. Samie, MD, PhD a,
a Department of Dermatology, Columbia University Irving Medical Center, New York, New York 
b Department of Dermatology, University of Arizona College of Medicine, Phoenix, Arizona 
c Department of Biostatistics, Columbia University Irving Medical Center, New York, New York 

Correspondence to: Faramarz H. Samie, MD, PhD, 161 Fort Washington Ave, New York, NY 10032.161 Fort Washington AveNew YorkNY10032
Abstract
Background

The use of immunotherapies in the treatment of metastatic cancers has significantly advanced oncology. However, due to safety concerns, solid organ transplant recipients (SOTRs) are routinely excluded from immunotherapy trials; thus, there is limited data for these agents in this population.

Methods

A systematic review was performed to evaluate the safety and efficacy of immunotherapies in SOTRs with metastatic cancers. Fisher's exact test and Kruskal-Wallis test were used for analysis.

Results

In total, 37% of patients experienced organ rejection, and 14% died as a result of graft rejection. Nivolumab was associated with the highest rejection rate (52.2%), followed by pembrolizumab (26.7%) and ipilimumab (25%; P  = .1774). The highest rejection rate was seen in patients with kidney transplants (40.1%), then liver (35%) and heart (20%) transplants (P  = .775), and 64% of patients succumbed to the progression of malignancy. For all cases, rates of progression or death secondary to disease were highest for ipilimumab (75%), followed by nivolumab (43%) and pembrolizumab (40%; P  = .1892). The overall response rate was highest for pembrolizumab (40%), followed by nivolumab (30%) and ipilimumab (25%; P  = .7929).

Limitations

The small sample size.

Conclusion

Physicians must be cautious when administering immunotherapy to SOTRs. However, rejection is not the most common cause for death in this population.

The full text of this article is available in PDF format.

Key words : allograft rejection, CTLA-4 inhibitors, immune checkpoint inhibitors, PD-1 inhibitors, solid organ transplant

Abbreviations used : cSCC, CTLA-4, MCC, MM, PD-1, PD-L1, SOTR



 Funding sources: None.
 Conflicts of interest: Dr Zeitouni is a speaker for Genentech, Sanofi, and Biofrontera and has received research grants from Biofrontera and SunPharma. She is also on the advisory board for Sanofi and a consultant for InMed Pharmaceuticals. Dr Fisher, Ms Fan, and Dr Samie have no conflicts of interest to disclose.
 Reprints not available from the authors.



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