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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
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.
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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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