BI05 How do we manage organ transplant recipients after their first cutaneous squamous cell carcinoma: the UK multicentre Contemporary Outcomes After cutaneous SCC in Transplant recipients study

Abstract

Abstract Cutaneous squamous cell carcinoma (cSCC) is the most common malignancy in organ transplant recipients (OTRs). Previous studies have shown that up to 75% of OTRs develop further skin cancer after their first cSCC. Interventions aimed at reducing this risk include modification of immunosuppression. However, a recent Delphi study has highlighted the lack of evidence regarding the optimal timing and nature of immunosuppression modification, and the frequency of utilization and impact of this approach at time of first cSCC is unknown. The COAST (Contemporary Outcomes After cutaneous SCC in Transplant recipients) study is a multicentre retrospective cohort study aiming to investigate contemporary management and outcomes after the first cSCC in kidney transplant recipients in the UK as a baseline for informing future interventional studies. We identified 119 consecutive kidney/kidney–pancreas transplant recipients across six centres in whom a first-ever cSCC was histologically confirmed. Median cumulative duration of immunosuppression to first cSCC was 143 months (range 5–480), median age at diagnosis was 63 years (range 44–87), 77% were male, 24% had a previous transplant, 37% had a previous skin malignancy other than cSCC and 8% had two or more cSCCs excised at the same time. Two-thirds of the first cSCCs were located on the head and neck, the median diameter was 12 mm (range 2–60) and TNM staging was T1 (64%), T2 (17%) and T3 (20%). After the first cSCC, 20% of OTRs had another cSCC within 12 months, 30% by 24 months and > 50% by 4 years. During the immediate follow-up (within 6 months of the first cSCC), immunosuppression was modified in 32.8% (n = 39/119) of patients (immunosuppression arm), and in 41% (n = 16/39) it was explicitly stated to be a result of cSCC diagnosis. During a median follow-up of 36 months (range 0–80; interquartile range 24–52), 21/39 (54%) in the IM arm had further cSCC(s), seven (17.9%) had metastatic cSCC, nine (23%) had graft loss, five (13%) developed further noncutaneous malignancies and 11 (28%) died during follow-up. In the nonimmunosuppression arm (n = 79), 31 (39%) had further cSCC(s), 6 (8%) had metastatic cSCC, 13 (16%) had graft loss, eight (10%) developed further noncutaneous malignancies and 18 (23%) died during follow-up. In this study, early modification of immunosuppression following a cSCC diagnosis was not associated with improved cancer-related outcomes. This may partly be explained by confounders, possible clinician selection of high-risk patients for immunosuppression modification, the 6-month window studied and the small sample size, which is the subject of ongoing analyses. Further prospective studies are urgently needed to evaluate the optimal timing and regime for immunosuppression modification for optimizing patient outcomes.