Abstract
BackgroundTransplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma. The efficacy and toxicity profiles of checkpoint inhibitors in this cohort of patients are not well described. To the best of our knowledge, this is the first case report of a renal transplant patient with stage IV melanoma treated with a programmed cell death protein 1 checkpoint inhibitor that led to both treatment failure and renal graft rejection.Case presentationWe present a case of a 58-year-old white man with a long-standing cadaveric renal transplant who was diagnosed with a B-Raf Proto-Oncogene, Serine/Threonine Kinase wild-type metastatic melanoma. He was treated with first-line pembrolizumab but experienced subsequent graft failure and rapid disease progression.ConclusionsThis case highlights the risks associated with the administration of checkpoint inhibitors in patients with a renal transplant and on immunosuppressive therapy. More specifically, it adds to the literature indicating that, compared with the cytotoxic T-lymphocyte-associated protein 4 inhibitor ipilimumab, anti-programmed cell death protein 1 agents are more likely to lead to renal graft failure. Additionally, these novel immunotherapeutics may be ineffective in transplant patients; therefore, clinicians should be very aware of those risks and carefully consider selection of agents and full disclosure of the risks to their patients.
Highlights
Transplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma
It adds to the literature indicating that, compared with the cytotoxic T-lymphocyte-associated protein 4 inhibitor ipilimumab, anti-programmed cell death protein 1 agents are more likely to lead to renal graft failure
We describe a case of a renal transplant patient with stage IVB-Raf Proto-Oncogene, Serine/Threonine Kinase (BRAF) wild-type melanoma who was treated with firstline pembrolizumab that led to subsequent graft rejection and rapid disease progression
Summary
Renal transplant patients with stage IV melanoma are more likely to maintain their graft and have a response if treated with ipilimumab than if they are treated with anti-PD-1 agents [5]. Ipilimumab should be considered as first-line therapy in renal transplant patients with stage IV melanoma requiring treatment with immunotherapy. As highlighted by our patient’s case, there is always a risk of graft failure and disease progression in kidney transplant recipients on immunosuppressive therapy who are treated with checkpoint blockade. These patients should be made aware of this risk
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