Immune checkpoint blockade for organ transplant patients with advanced cancer: how far can we go?
Open accessAbstract
PURPOSE OF REVIEW: Checkpoint inhibitors (CPIs) provide impressive response rates among immunocompetent patients with various solid tumors. So far, organ transplant recipients have been excluded from clinical studies due to the putative risk of allograft rejection however 48 cases of liver and renal transplant patients treated with CPI were already described in literature. RECENT FINDINGS: Here we discuss 19 cases of liver and 29 cases of renal transplant patients who received CPI for advanced cancer. Disease control rate [stable disease, complete response (CR) and partial response (PR) together] was 35% (21% for liver and 45% for kidney transplant patients). Graft rejection was seen in 37% of liver and 45% and kidney transplant patients. Significantly, our analysis shows that an 'ideal' response occurs in 21% of all patients (antitumor response accompanied with durable graft tolerance). SUMMARY: We believe that transplant patients can be treated with CPI in a controlled setting and for well informed patients. To obtain a durable antitumor immune response while avoiding rejection, to be able to adjust immunosuppression and to have the opportunity to develop biomarkers for tumor response and transplant rejection, these patients should be treated according to a clinical care path or a prospective clinical trial.
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Another review showed a global tumor control rate of 35% (0% for recurrent hepatocellular carcinoma patients, 44% for non-recurrent hepatocellular carcinoma liver transplant patients, and 45% for kidney transplant patients).
“Another review showed an encouraging global tumor control rate of 35% (0% for recurrent hepatocellular carcinoma patients, 44% for non-recurrent hepatocellular carcinoma liver transplant patients, and 45% for kidney transplant patients).”
From Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: Review of the literature and personalized risk-based prevention strategy (2020) · cites this paper as [157]
Almost two-thirds of the patients experienced allograft preservation.
“Significantly, almost two-thirds of the patients experienced allograft preservation.157”
From Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: Review of the literature and personalized risk-based prevention strategy (2020) · cites this paper as [157]
More immunosuppression to prevent allograft rejection counteracts the clinical benefits of ICIs.
“This, of course, counteracts the clinical benefits of ICIs9,10.”
From Targeting the mTOR pathway uncouples the efficacy and toxicity of PD-1 blockade in renal transplantation (2019) · cites this paper as [9]
Cancer immunotherapy results in organ rejection in the majority of patients with renal transplants who are candidates for ICIs.
“Cancer immunotherapy results in organ rejection in the majority of these patients, requiring more immunosuppression to prevent allograft rejection and graft loss7–9.”
From Targeting the mTOR pathway uncouples the efficacy and toxicity of PD-1 blockade in renal transplantation (2019) · cites this paper as [9]
Key recent reviews of all transplant cases treated with ICIs highlight the vast heterogeneity of immunosuppression regimens used and the void of translational data guiding treatment decisions.
“Key recent reviews of all the transplant cases treated with ICIs highlight the vast heterogeneity of the immunosuppression regimens used in this setting the void of any translational data guiding treatment decisions7–9.”
From Targeting the mTOR pathway uncouples the efficacy and toxicity of PD-1 blockade in renal transplantation (2019) · cites this paper as [9]
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- Authors
- De Bruyn, P., Van Gestel, D., Ost, P., Kruse, V., Brochez, L., Van Vlierberghe, H., Devresse, A., del Marmol, V., Le Moine, A., & Aspeslagh, S.
- Affiliations
- Department of Radiation Oncology, Institut Jules Bordet – ULB, Brussels
- Department of Radiation Oncology
- Department of Medical Oncology
- Department of Dermatology
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent
- Cliniques Universitaires Saint-Luc (BE)
- Department of Nephrology, Erasme Hospital
- Vrije Universiteit Brussel (BE)
- Corresponding author
- Aspeslagh, Sandrine
- Venue
- Current Opinion in Oncology
- Published
- 2019-03
- Volume
- 31
- Issue
- 2
- Pages
- 54-64
- ISSN
- 1040-8746 (ISSN-L)
- 1531-703X
- OpenAlex
- W2920257990
- Cited by
- 79
- References
- 60
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 9 · 2023: 11 · 2022: 11 · 2021: 14 · 2020: 18 · 2019: 13
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- green
- biblio.ugent.be
- Licence
- other-oa
- Locations
- Current Opinion in Oncology (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- Digital Access to Libraries (submittedVersion, other-oa)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Transplantation › Organ and Tissue Transplantation Research
- Keywords
- immune checkpoint inhibitors, organ transplant recipients, liver transplantation, kidney transplantation, allograft rejection, graft tolerance, advanced cancer, immunosuppression, antitumor immunity, inclusion and exclusion criteria
- MeSH terms
- Antineoplastic Agents, Immunological, Graft Rejection, Humans, Immunosuppressive Agents, Liver Neoplasms, Kidney Transplantation, CTLA-4 Antigen, Programmed Cell Death 1 Receptor
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