A multi-center study on safety and efficacy of immune checkpoint inhibitors in cancer patients with kidney transplant.

Carcinoma, Squamous Cell / drug therapy Humans Immune Checkpoint Inhibitors Kidney Transplantation / adverse effects Prospective Studies Retrospective Studies Skin Neoplasms / drug therapy
immune checkpoint inhibitors kidney transplant onconephrology rejection

Journal

Kidney international
ISSN: 1523-1755
Titre abrégé: Kidney Int
Pays: United States
ID NLM: 0323470

Informations de publication

Date de publication:
07 2021
Historique:
received: 01 09 2020
revised: 03 11 2020
accepted: 07 12 2020
pubmed: 29 12 2020
medline: 29 6 2021
entrez: 28 12 2020
Statut: ppublish

Résumé

Immune checkpoint inhibitors (ICIs) are widely used for various malignancies. However, their safety and efficacy in patients with a kidney transplant have not been defined. To delineate this, we conducted a multicenter retrospective study of 69 patients with a kidney transplant receiving ICIs between January 2010 and May 2020. For safety, we assessed the incidence, timing, and risk factors of acute graft rejection. For efficacy, objective response rate and overall survival were assessed in cutaneous squamous cell carcinoma and melanoma, the most common cancers in our cohort, and compared with stage-matched 23 patients with squamous cell carcinoma and 14 with melanoma with a kidney transplant not receiving ICIs. Following ICI treatment, 29 out of 69 (42%) patients developed acute rejection, 19 of whom lost their allograft, compared with an acute rejection rate of 5.4% in the non-ICI cohort. Median time from ICI initiation to rejection was 24 days. Factors associated with a lower risk of rejection were mTOR inhibitor use (odds ratio 0.26; 95% confidence interval, 0.09-0.72) and triple-agent immunosuppression (0.67, 0.48-0.92). The objective response ratio was 36.4% and 40% in the squamous cell carcinoma and melanoma subgroups, respectively. In the squamous cell carcinoma subgroup, overall survival was significantly longer in patients treated with ICIs (median overall survival 19.8 months vs. 10.6 months), whereas in the melanoma subgroup, overall survival did not differ between groups. Thus, ICIs were associated with a high risk of rejection in patients with kidney transplants but may lead to improved cancer outcomes. Prospective studies are needed to determine optimal immunosuppression strategies to improve patient outcomes.

Identifiants

DOI: 10.1016/j.kint.2020.12.015 PMID: 33359528 PMC: PMC8222056
pubmed: 33359528
pii: S0085-2538(20)31534-9
doi: 10.1016/j.kint.2020.12.015
pmc: PMC8222056
mid: NIHMS1659235
pii:
doi:

Substances chimiques

Immune Checkpoint Inhibitors 0

Types de publication

Journal Article Multicenter Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

196-205

Subventions

Organisme : NIDDK NIH HHS
ID : K08 DK120868
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK117014
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK114321
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI143887
Pays : United States

Informations de copyright

Copyright © 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

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Auteurs

Naoka Murakami (N)

Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: nmurakami1@bwh.harvard.edu.

Patrick Mulvaney (P)

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Melissa Danesh (M)

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Ala Abudayyeh (A)

Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Adi Diab (A)

Department of Melanoma Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Noha Abdel-Wahab (N)

Department of Melanoma Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.

Maen Abdelrahim (M)

Institute for Academic Medicine and Weill Cornell Medical College, Houston Methodist Cancer Center, Houston, Texas, USA.

Pascale Khairallah (P)

Division of Nephrology, Columbia University Medical Center, New York, New York, USA.

Shayan Shirazian (S)

Division of Nephrology, Columbia University Medical Center, New York, New York, USA.

Aleksandra Kukla (A)

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.

Itunu O Owoyemi (IO)

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.

Tarek Alhamad (T)

Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri, USA.

Samir Husami (S)

Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri, USA.

Madhav Menon (M)

Division of Nephrology, Recanati Millar Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Andrew Santeusanio (A)

Division of Nephrology, Recanati Millar Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Christopher D Blosser (CD)

Divison of Nephrology, University of Washington, Seattle, Washington, USA.

Sandra Carias Zuniga (SC)

Divison of Nephrology, University of Washington, Seattle, Washington, USA.

Maria Jose Soler (MJ)

Nephrology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain.

Francesc Moreso (F)

Nephrology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain.

Zain Mithani (Z)

Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida, USA.

David Ortiz-Melo (D)

Division of Nephrology, Duke University Medical Center, Durham, North Carolina, USA.

Edgar A Jaimes (EA)

Renal Service, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, New York, USA.

Victoria Gutgarts (V)

Renal Service, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, New York, USA.

Erik Lum (E)

Division of Nephrology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.

Gabriel M Danovitch (GM)

Division of Nephrology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.

Francesca Cardarelli (F)

Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Reed E Drews (RE)

Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Claude Bassil (C)

Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida; Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.

Jennifer L Swank (JL)

Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida; Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.

Scott Westphal (S)

Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA.

Roslyn B Mannon (RB)

Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA.

Keisuke Shirai (K)

Department of Hematology-Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

Abhijat Kitchlu (A)

Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada.

Song Ong (S)

Division of Nephrology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.

Shana M Machado (SM)

Division of Nephrology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.

Suraj S Mothi (SS)

Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Patrick A Ott (PA)

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

Osama Rahma (O)

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

F Stephen Hodi (FS)

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

Meghan E Sise (ME)

Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Shruti Gupta (S)

Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

David E Leaf (DE)

Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Craig E Devoe (CE)

Division of Medical Oncology and Hematology, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA.

Rimda Wanchoo (R)

Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.

Vinay V Nair (VV)

Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.

Chrysalyne D Schmults (CD)

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Glenn J Hanna (GJ)

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

Ben Sprangers (B)

Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Belgium; Department of Nephrology, University Hospitals Leuven, Leuven, Belgium.

Leonardo V Riella (LV)

Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.

Kenar D Jhaveri (KD)

Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA. Electronic address: Kjhaveri@northwell.edu.

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Classifications MeSH

questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Tumeurs épidermoïdes › Carcinome épidermoïde › A multi-center study on safety and efficacy of...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A multi-center study on safety and efficacy of...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Antinéoplasiques › Antinéoplasiques immunologiques › Inhibiteurs de points de contrôle immunitaires › A multi-center study on safety and efficacy of...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Transplantation rénale › A multi-center study on safety and efficacy of...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › A multi-center study on safety and efficacy of...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › A multi-center study on safety and efficacy of...
questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Tumeurs cutanées › A multi-center study on safety and efficacy of...