Efficacy and tolerance of immune checkpoint inhibitors in transplant patients with cancer: A systematic review

Am J Transplant. 2020 Sep;20(9):2457-2465. doi: 10.1111/ajt.15811. Epub 2020 Mar 21.

Abstract

Solid organ transplant (SOT) is frequently complicated by cancers, which render immunosuppression challenging. Immune checkpoint inhibitors have emerged as treatments for many cancers. Data are lacking regarding efficacy and rejection risk in the SOT population. We conducted a systematic literature review and analyzed 83 cases of immune checkpoint inhibitor use for cancer in SOT. Two thirds of these patients received anti-programmed death ligand 1 therapy, 15.7% received anti-cytotoxic T lymphocyte-associated protein 4 therapy, and 10.8% received a combination. Allograft rejection occurred in 39.8% of patients, leading to end-stage organ failure in 71.0% of cases. Outcomes were similar across organs and immunotherapy regimens. The use of immunosuppressants other than steroids, time since transplant, and prior episodes of rejection were associated with the risk of rejection. The median overall survival of patients was 36 weeks. Most of the deaths were related to cancer progression. In nonkidney recipients, graft rejection was strongly associated with worse survival. At the end of the study, 19.3% of the patients were alive, free from rejection and tumor progression. This study highlights the difficult tradeoff facing oncologists and transplant specialists managing transplant recipients with cancer, and the need for prospective data and novel biomarkers for identifying the patients likely to benefit from immunotherapy in the SOT setting.

Keywords: cancer/malignancy/neoplasia; cancer/malignancy/neoplasia: adjuvant therapy; clinical research/practice; drug toxicity; hematology/oncology; kidney (allograft) function/dysfunction.

Publication types

  • Systematic Review

MeSH terms

  • Graft Rejection / etiology
  • Humans
  • Immune Checkpoint Inhibitors
  • Immunosuppressive Agents / therapeutic use
  • Neoplasms* / drug therapy
  • Organ Transplantation* / adverse effects
  • Prospective Studies

Substances

  • Immune Checkpoint Inhibitors
  • Immunosuppressive Agents