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Immune checkpoint blockade for organ transplant patients with advanced cancer

how far can we go?

De Bruyn, Paulinea; Van Gestel, Dirka; Ost, Pietb; Kruse, Vibekec; Brochez, Lieved; Van Vlierberghe, Hanse; Devresse, Arnaudf; del Marmol, Véroniqueg; Le Moine, Alainh; Aspeslagh, Sandrineg,i,j,k

doi: 10.1097/CCO.0000000000000505
MELANOMA AND OTHER SKIN NEOPLASMS: Edited by Véronique del Marmol

Purpose of review Checkpoint inhibitors (CPIs) provide impressive response rates among immunocompetent patients with various solid tumors. So far, organ transplant recipients have been excluded from clinical studies due to the putative risk of allograft rejection however 48 cases of liver and renal transplant patients treated with CPI were already described in literature.

Recent findings Here we discuss 19 cases of liver and 29 cases of renal transplant patients who received CPI for advanced cancer. Disease control rate [stable disease, complete response (CR) and partial response (PR) together] was 35% (21% for liver and 45% for kidney transplant patients). Graft rejection was seen in 37% of liver and 45% and kidney transplant patients. Significantly, our analysis shows that an ‘ideal’ response occurs in 21% of all patients (antitumor response accompanied with durable graft tolerance).

Summary We believe that transplant patients can be treated with CPI in a controlled setting and for well informed patients. To obtain a durable antitumor immune response while avoiding rejection, to be able to adjust immunosuppression and to have the opportunity to develop biomarkers for tumor response and transplant rejection, these patients should be treated according to a clinical care path or a prospective clinical trial.

aDepartment of Radiation Oncology, Institut Jules Bordet – ULB, Brussels

bDepartment of Radiation Oncology

cDepartment of Medical Oncology

dDepartment of Dermatology

eDepartment of Gastroenterology and Hepatology, Ghent University Hospital, Ghent

fDepartment of Nephrology, University Hospital St-Luc – UCL

gDepartment of Dermatology

hDepartment of Nephrology, Erasme Hospital

iDepartment of Medical Oncology, Institut Jules Bordet – ULB

jDepartment of Medical Oncology, UZBrussel – VUB

kDepartment of Medical Oncology, Erasme Hospital-ULB, Brussels, Belgium

Correspondence to Sandrine Aspeslagh, Department of Radiation Oncology, Vrij Universiteit Brussels VUB, Laarbeeklaan 101 - 1090 Brussel, Belgium. E-mail: Sandrine.aspeslagh@uzbrussel.be

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