RT Journal Article
SR Electronic
T1 Antitumor activity of nivolumab on hemodialysis after renal allograft rejection
JF Journal for ImmunoTherapy of Cancer
JO J Immunother Cancer
FD BMJ Publishing Group Ltd
SP 64
DO 10.1186/s40425-016-0171-8
VO 4
IS 1
A1 Ong, Michael
A1 Ibrahim, Andrea Marie
A1 Bourassa-Blanchette, Samuel
A1 Canil, Christina
A1 Fairhead, Todd
A1 Knoll, Greg
YR 2016
UL http://jitc.bmj.com/content/4/1/64.abstract
AB Background Nivolumab (Opdivo™) is a novel IgG4 subclass programmed death-1 (PD-1) inhibiting antibody that has demonstrated breakthrough-designation anti-tumor activity. To date, clinical trials of nivolumab and other checkpoint inhibitors have generally excluded patients with solid organ transplantation and patients with concurrent immunosuppression. However, organ transplant recipients are at high-risk of development of malignancy as a result of suppressed immune surveillance of cancer.Case presentation We illustrate the outcomes of a 63 year-old type I diabetic female patient who developed pulmonary metastatic, BRAF wild-type cutaneous melanoma 10 years after renal transplantation. After downward titration of the patient’s immunosuppressive medications and extensive multidisciplinary review, she was treated with nivolumab in the first-line setting. Within 1 week of administration, the patient experienced acute renal allograft rejection, renal failure and concurrent diabetic ketoacidosis due to steroid therapy. Allograft function did not return, but patient made a full clinical recovery after being placed on hemodialysis. Subsequently, the patient had clinical disease progression off therapy and required re-challenge with nivolumab on hemodialysis, resulting in ongoing clinical and radiographic response.Conclusions This case illustrates multiple practical challenges and dangers of administering anti-PD1 immune checkpoint inhibitors to patients with solid-organ transplantation including need for titration of immunosuppressive medications, risks of allograft rejection, and treatment during hemodialysis.Abbreviations:CTLA-4Anti-cytotoxic T-lymphocyte-associated protein-4FDGFluorodeoxyglucoseGFRGlomerular filtration rateIgG-4Immunoglobulin G-4irRCImmune-related response criteriaIVIntravenousPCRPolymerase chain reactionPD-1Programmed death receptor-1PD-L1Programmed death receptor-1 ligandPET-CTPositron emission tomography-computed tomographyRLLRight lower lobeSOTRSolid organ transplant recipientSUVStandardized uptake value