Clinical trials show that certain immunosuppressants and immunotherapies are not sufficient to prevent organ rejection in patients treated for skin cancer who also receive kidney transplants published inside Journal of Clinical Oncology.
According to the National Institutes of Health, people who have received an organ transplant are two to four times more likely to develop cancer, and are especially at risk for skin cancer.
Because traditional chemotherapy and immunotherapy can cause rejection of transplanted organs, transplant recipients with skin cancer are often excluded from clinical trials and have limited treatment options. he said. Sunandana Chandra, MD, MS,Associate Professor medicine in the department of hematology oncology He is also a co-author of the study.
“Currently, we can only study the effects of immunotherapy in skin cancer patients who have received kidney transplants if the patients are willing to accept the potential risks of transplant rejection and subsequent initiation of dialysis.” said one Chandra.of Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “Despite the high unmet need for effective systemic skin cancer treatments in kidney transplant patients, these patients have historically not been the target of clinical trials, and therefore have not been systematically and appropriately designed. It is generally not possible to study it prospectively in trials.”
In this study, researchers gave kidney transplant recipients with skin cancer the cancer immunotherapy drugs nivolumab and ipilimumab, as well as the immunosuppressive drug tacrolimus and the anti-inflammatory drug prednisone. According to the study, patients received tacrolimus and prednisone once daily, followed by immunotherapy with nivolumab.
After 16 weeks of treatment, researchers found that tacrolimus and prednisone were not enough to prevent organ loss in kidney transplant patients with skin cancer. Of the eight patients in the study, all experienced continued tumor growth despite immunotherapy, and one patient experienced treatment-related donor organ loss.
“The lesson we learned here is that we need to re-evaluate the types of immunosuppressants we are treating these patients with, and perhaps the types and doses of immunosuppressants used in this trial were insufficient. “We also need to think about how we administer immunotherapy drugs,” Chandra said.
The information the researchers have learned will now be incorporated into an updated clinical trial in kidney transplant patients with skin cancer, he said.
“We want to see if we can find ways to increase the efficacy, that is, increase the effectiveness of these drugs against these cancers, but also reduce the risk to donor organs. ” said Chandra. “The lack of trials in these patients is alarming, and we are trying to change that.”
This research was supported by National Cancer Institute Grant UM1 CA186691, the Bloomberg Kimmel Institute for Cancer Immunotherapy, the Marilyn and Michael Grosserman Fund for Basal Cell Carcinoma and Melanoma Research, and the Mary Moving for Melanoma Foundation. Supported in part by the Joe and Brian C. Rogers Foundation. State of Delaware, Barney Family Foundation, Ravana Hahn Charitable Trust, Bristol-Myers Squibb, Raymond and Melody Ranelli Foundation.
