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

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

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, but to the authors' knowledge, limited data exist regarding the safety and efficacy of these agents in transplant recipients. Herein, the authors have reported their experience with 17 patients who were treated with ICIs for metastatic malignancies after undergoing solid organ transplantation. Methods: Data were abstracted for solid organ transplant recipients who received ICIs for the treatment of malignancy between January 1, 2016, and September 30, 2019. The authors identified 7 kidney, 8 liver, and 2 heart transplant recipients. Outcomes of interest were adverse drug reactions, cancer progression, and patient survival. Results: The most common malignancies treated with ICIs were metastatic squamous cell carcinoma (5 patients; 29%) and hepatocellular carcinoma (5 patients; 29%), which were noted exclusively among liver transplant recipients. The median duration on ICIs was 1.7 months (interquartile range, 0.4-7.6 months). Five patients (29%) developed adverse reactions, including 4 patients (24%) with immune-related adverse events(irAEs), 3 patients (18%) with acute allograft rejections, 1 patient (6%) with autoimmune colitis, and 1 patient (6%) with ICI-induced cardiotoxicity (the patient was a heart transplant recipient). The cumulative incidence of cancer progression was 50% and 69%, respectively, at 6 months and 12 months. Eleven patients (65%) died over the median follow-up period of 4.6 months (interquartile range, 1.5-13.2 months) from the time of ICI initiation, with cancer progression being the most common cause of death. Conclusions: ICIs can be used as individualized therapy in selected patients who have undergone solid organ transplantation but more studies are needed to determine how best to use these agents to improve outcomes further.

Original languageEnglish (US)
Pages (from-to)4780-4787
Number of pages8
JournalCancer
Volume126
Issue number21
DOIs
StatePublished - Nov 1 2020

Keywords

  • advanced metastatic cancers
  • allograft rejection
  • cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitors
  • immune checkpoint inhibitors
  • programmed cell death protein 1 (PD-1) inhibitors
  • programmed death–ligand 1 (PD-L1) inhibitors
  • solid organ transplant recipients

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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