Immunotherapy combinations may aid patients with advanced skin cancers following kidney transplants

In the Experimental Therapeutics Clinical Trials Network trial, eight kidney transplant recipients with advanced skin cancers received low-dose tacrolimus and prednisone, followed by nivolumab. Upon progression, ipilimumab was added to treatment in six patients. Donor-derived cell-free DNA levels were also monitored every two weeks to explore their potential as a predictor of graft rejection.

Researchers observed that the tumour biopsies demonstrated increased immune activity against cancer with nivolumab, and a complete response in two patients after ipilimumab addition. Additionally, donor-derived cell-free DNA levels rose before serum creatinine increased, indicating a potential for predicting kidney damage from trial medications.

“The completed study introduced two checkpoint inhibitors sequentially because we didn’t want to risk overstimulating the patient’s immune system and harm the transplanted organ,” Lipson said. “But some cutaneous tumors grow so quickly we can’t wait to give a second immunotherapy drug months after starting a first.”

“Going forward, this knowledge may help us intervene earlier and better preserve the transplanted organ, a precious resource,” concluded Lipson.

Reference: DC Dapprich, RH Weenig, AL Rohlinger, etal: Outcomes of melanoma in recipients of solid organ transplant J Am Acad Dermatol 59: 405– 417,2008; https://doi.org/10.1200/JCO.2013.49.2314