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Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients
BACKGROUND: Immune checkpoint blockade has emerged as a highly effective treatment for patients with metastatic melanoma and cutaneous squamous cell carcinoma. Nivolumab blocks the interactions between programmed cell death protein 1 and programmed death ligand 1 allowing for activation of a latent...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279669/ https://www.ncbi.nlm.nih.gov/pubmed/32503950 http://dx.doi.org/10.1136/jitc-2020-000908 |
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author | Trager, Megan H Coley, Shana M Dube, Geoffrey Khan, Shaheer Ingham, Matthew Samie, Faramarz H Geskin, Larisa J McDonnell, Diana Brouder, Daniel Saenger, Yvonne Carvajal, Richard |
author_facet | Trager, Megan H Coley, Shana M Dube, Geoffrey Khan, Shaheer Ingham, Matthew Samie, Faramarz H Geskin, Larisa J McDonnell, Diana Brouder, Daniel Saenger, Yvonne Carvajal, Richard |
author_sort | Trager, Megan H |
collection | PubMed |
description | BACKGROUND: Immune checkpoint blockade has emerged as a highly effective treatment for patients with metastatic melanoma and cutaneous squamous cell carcinoma. Nivolumab blocks the interactions between programmed cell death protein 1 and programmed death ligand 1 allowing for activation of a latent immune response against the malignancy. Ipilimumab binds to and blocks cytotoxic T-lymphocyte-associated protein 4, alleviating the negative regulation of T-cell activation that is mediated by that checkpoint. Combination therapy with nivolumab and ipilimumab is associated with longer overall survival at 5 years compared with nivolumab monotherapy. Solid organ transplant recipients have a significantly higher risk of malignancies compared with the general population. There is limited data surrounding the efficacy of combination immunotherapy in solid organ transplant recipients, as these patients were excluded from seminal trials due to risk of organ rejection. CASE PRESENTATIONS: Here we present four cases of combination immunotherapy in kidney transplant recipients. Three patients had metastatic melanoma, and one patient had metastatic cutaneous squamous cell carcinoma. Two patients had radiographic responses from immunotherapy, one patient had stable disease, and one patient had disease progression. Only one patient had biopsy-proven rejection. At last follow-up, three patients had functioning grafts, though one required hemodialysis after treatment, and one patient succumbed to disease, but graft function remained intact throughout her course. CONCLUSIONS: These cases describe the use of ipilimumab and nivolumab combination immunotherapy for cutaneous malignancies in kidney transplant recipients. They highlight the potential to preserve kidney graft function while effectively treating the disease. |
format | Online Article Text |
id | pubmed-7279669 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-72796692020-06-15 Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients Trager, Megan H Coley, Shana M Dube, Geoffrey Khan, Shaheer Ingham, Matthew Samie, Faramarz H Geskin, Larisa J McDonnell, Diana Brouder, Daniel Saenger, Yvonne Carvajal, Richard J Immunother Cancer Case Report BACKGROUND: Immune checkpoint blockade has emerged as a highly effective treatment for patients with metastatic melanoma and cutaneous squamous cell carcinoma. Nivolumab blocks the interactions between programmed cell death protein 1 and programmed death ligand 1 allowing for activation of a latent immune response against the malignancy. Ipilimumab binds to and blocks cytotoxic T-lymphocyte-associated protein 4, alleviating the negative regulation of T-cell activation that is mediated by that checkpoint. Combination therapy with nivolumab and ipilimumab is associated with longer overall survival at 5 years compared with nivolumab monotherapy. Solid organ transplant recipients have a significantly higher risk of malignancies compared with the general population. There is limited data surrounding the efficacy of combination immunotherapy in solid organ transplant recipients, as these patients were excluded from seminal trials due to risk of organ rejection. CASE PRESENTATIONS: Here we present four cases of combination immunotherapy in kidney transplant recipients. Three patients had metastatic melanoma, and one patient had metastatic cutaneous squamous cell carcinoma. Two patients had radiographic responses from immunotherapy, one patient had stable disease, and one patient had disease progression. Only one patient had biopsy-proven rejection. At last follow-up, three patients had functioning grafts, though one required hemodialysis after treatment, and one patient succumbed to disease, but graft function remained intact throughout her course. CONCLUSIONS: These cases describe the use of ipilimumab and nivolumab combination immunotherapy for cutaneous malignancies in kidney transplant recipients. They highlight the potential to preserve kidney graft function while effectively treating the disease. BMJ Publishing Group 2020-06-04 /pmc/articles/PMC7279669/ /pubmed/32503950 http://dx.doi.org/10.1136/jitc-2020-000908 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Case Report Trager, Megan H Coley, Shana M Dube, Geoffrey Khan, Shaheer Ingham, Matthew Samie, Faramarz H Geskin, Larisa J McDonnell, Diana Brouder, Daniel Saenger, Yvonne Carvajal, Richard Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients |
title | Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients |
title_full | Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients |
title_fullStr | Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients |
title_full_unstemmed | Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients |
title_short | Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients |
title_sort | combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279669/ https://www.ncbi.nlm.nih.gov/pubmed/32503950 http://dx.doi.org/10.1136/jitc-2020-000908 |
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