Secondary skin-cancer risk after kidney transplantation

Abstract

Recipients of kidney transplants who switch from calcineurin inhibitors to sirolimus are at reduced risk of develop ment of secondary skin cancer, according to fi ndings of a multicentre trial published last week. Some evidence suggests that the immunosuppressant mTOR inhibitor sirolimus could decrease tumour burden. Transplant patients are required to take immuno suppressive drugs to forestall organ rejection, but are at high risk of skin cancer. Researchers for the TUMORAPA study group assessed 120 recipients of kidney transplants who were taking calcineurin inhibitors (tacrolimus and ciclosporin) and had previously had at least one cutaneous squamous-cell carcinoma. 64 patients switched to sirolimus and 56 patients remained on calcineurin inhibitors. 14 patients (22%) in the sirolimus group developed secondary skin cancer compared with 22 patients (39%) in the control group. Moreover, patients in the sirolimus group developed new carcinomas later than did controls (15 months vs 7 months). The sooner the conversion to sirolimus occurred after the initial cancer diagnosis, the better the patient’s prognosis. “We’ve been [starting to use] sirolimus over the past few years”, Jerry Brewer (Mayo Clinic, MN, USA) told The Lancet Oncology. “This study provides further evidence that it should be used more frequently.” Complications associated with sirolimus are an important con sid eration. “We had to stop treatment for a signifi cant number of patients because of pneumonitis and proteinuria”, affi rmed study investigator Eric Goffi n (St Luc University Hospital, Brussels). 15 patients (23%) in the sirolimus group discontinued treat ment due to adverse events. Moreover, nearly all the patients had some kind of negative side-eff ect, most of which were manageable with dose reductions or complemen tary treatment. Patients who were gradually introduced to sirolimus were less prone to adverse events than were those converted with rapid protocols. As long as a transplant recipient has suffi ciently high kidney functionality, low levels of proteinuria, and can tolerate the drug, Goffi n advocates use of sirolimus. But whether patients in the immediate aftermath of a transplantation should be prescribed the drug has yet to be established. “There have been no really good studies on sirolimus right after surgery, but it does seem to inhibit wound healing”, explains Brewer.