Happy New Year! I thought I would get 2019 started off with a survey type question. What has been your experience with giving ICI therapy to patients status post solid organ transplant (SOT)? This has become an increasing hot topic, especially with the approval of cemiplimab in the SCC setting which encompasses a lot of SOT patients. Additionally we see a lot of secondary melanomas after transplant as well.
Happy New Year!
Great inquiry regarding transplant pts & the use of ICI’s. Our practice has a handful of transplant pts, we have tended to shy away from pd-1 inhibitiors due to some case studies of organ transplant rejection. Pts have in these cases been treated with a CTLA-4 inhibitor. However, some of the more recent case studies have a mix of pts receiving pd-1 or combination therapies and tolerating these therapies without rejection. We have not yet had a pt with met SCC related to immune suppression secondary to transplant, we have only treated standard of care pts with cemiplimab. More case studies and discussion are certainly needed to compile more risk vs benefit info.
I have a couple of patients right now receiving cemiplimab for met SCC. One is s/p renal transplant many many years ago, the other is not a transplant pt. Both pts are doing extremely well. One is having a fabulous response, with ongoing excellent renal function (better than when he started Rx in fact) and no sign of rejection thus far. The other has not yet been restaged, but is using much less opioid analgesia for related pain. That is a good sign. Too early to tell, but as we all gain more and more experience, it is great to share.