ReviewImmune checkpoint inhibitor therapy in solid organ transplant recipients: A patient-centered systematic review
Section snippets
Methods
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.13 A PubMed and Embase database search was performed for articles published up to January 6, 2019, without date restrictions. Search terms included “PD-1 inhibitor,” “immune checkpoint inhibitor,” “CTLA-4 inhibitor,” “ipilimumab transplant,” “nivolumab transplant,” and “pembrolizumab transplant.” Articles were screened by evaluating title and abstract for
Results
In total, 13 SOTRs, from 2 retrospective studies, and 44 SOTRs, from 34 case reports or series, who were treated with immunotherapies for various metastatic cancers were identified for inclusion. The detailed outcomes and demographics of each patient are reported in Table I.14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 In all reported cases, the use of ipilimumab, nivolumab, or pembrolizumab alone
Discussion
SOTRs require close monitoring and augmentation of immunosuppression in order to maintain graft function and prevent graft loss. Immunosuppressive medications act in direct opposition to PD-1 and CTLA-4 immunotherapies, which are used to enhance the cell-mediated immune response to cancer antigens. In mouse and human participant studies, the PD-1–PD-L1 interaction has been shown to be important in graft tolerance and counter-regulation of rejection.50, 51, 52 Furthermore, knockout of CTLA-4 in
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2023, Translational OncologyCitation Excerpt :In patients who relapse after transplantation, the dose of immunosuppressants is usually reduced before starting ICIs treatment to avoid potential interference of immunosuppressants with the antitumor effects of ICIs. It has been reported that replacing tacrolimus with mTOR inhibitors, such as rapamycin in combination with lowdose glucocorticoids during PD-1 inhibitor therapy, can reduce the risk of rejection [48–50]. Previous clinical studies have shown that compared to recipients using calcineurin inhibitors, recipients using mTOR inhibitors have a significantly lower rate of postoperative tumor recurrence, and systemic therapy with mTOR inhibitor combined with sorafenib in patients with HCC recurrence after liver transplantation can achieve a certain degree of survival benefit [51,52].
Funding sources: None.
Conflicts of interest: Dr Zeitouni is a speaker for Genentech, Sanofi, and Biofrontera and has received research grants from Biofrontera and SunPharma. She is also on the advisory board for Sanofi and a consultant for InMed Pharmaceuticals. Dr Fisher, Ms Fan, and Dr Samie have no conflicts of interest to disclose.
Reprints not available from the authors.