Abstract: FR-PO202
National Audit of Immune Checkpoint Inhibitor Use in Kidney Transplants
Session Information
- Onconephrology: Immunotherapy Nephrotoxicity and Assessment of GFR
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- O'Connell, Blathnaid, Beaumont Hospital, Dublin, Dublin, Ireland
- Cowhig, Cliona, Cork University Hospital, Cork, Cork, Ireland
- Hanko, Jennifer B., HCS Belfast Health and Social Care Trust, Belfast, United Kingdom
- Clarkson, Michael, Cork University Hospital, Cork, Cork, Ireland
- Conlon, Peter J., Beaumont Hospital, Dublin, Dublin, Ireland
Background
Cancer is one of the leading causes of death in kidney transplant patients. The incidence of skin cancers among solid organ transplant recipients (SOTR) is markedly higher than general population.
Immune checkpoint inhibitors (ICPIs) have revolutionized cancer treatment and have become standard of care for many cancers, including cutaneous malignancies. However, SOTR have been excluded from trials due to risk of allograft rejection, and because immunosuppression may compromise the anti-tumour effect of ICPIs.
To date, this is the first case series looking at outcomes of this patient cohort in Ireland.
Methods
This was a multicentre retrospective study assessing kidney transplant recipients treated with ICPIs in Ireland. Cases were identified by members of the Irish Nephrology Society. Data collection included demographics, history of the transplantation, tumour type, ICPI use, changes to immunosuppression and outcomes.
Results
Five patients were included (4 male, 1 female), aged 54–72 years. Three patients received DBD transplants + 2 received living related transplants. 80% had metastatic melanoma, 20% had metastatic squamous cell carcinoma. Four patients were maintained on calcineurin inhibitors (CNI), mycophenolate mofetil (MMF) & prednisolone prior to diagnosis. One was on a CNI & prednisolone alone. Three patients commenced pembrolizumab, one commenced nivolumab and one commenced ipilimumab/nivolumab. None had systemic cancer treatments.
MMF was stopped in all relevant cases, and prednisolone dose increased in one case. The majority weaned/stopped their CNI at ICPI initiation, but one switched from tacrolimus to sirolimus.
One patient had a transplant biopsy, showing borderline T-Cell mediated rejection.
Three patients (two on pembrolizumab, one on nivolumab) had reduction in metastatic burden and showed no evidence of disease progression at 25, 44 and 32 months, respectively and are currently maintained on treatment. All 3 returned to haemodialysis within 42-79 days of ICPI initiation.
Two patients died at 53 days & 67 days post ICPI initiation.
Conclusion
The efficacy of ICPIs in kidney transplant patients appears promising, warranting prospective clinical trials. There are currently no guidelines on the use of ICPIs in SOTR, but ultimately, when the question becomes of life versus graft, discussion between the patient & physician is crucial.