Ipilimumab for the treatment of advanced melanoma in six kidney transplant patients.
Am J Transplant. 2018 Aug 14;:
Authors: Zehou O, Leibler C, Arnault JP, Sayegh J, Montaudié H, Rémy P, Glotz D, Cordonnier C, Martin L, Lebbé C
Immune checkpoint inhibitors are new therapeutic options for metastatic melanoma, but little data is available in organ transplant recipient populations. Six French patients, 3 men and 3 women, mean age 66 years (range 44-74), all kidney transplant recipients, received ipilimumab (CTLA-4 inhibitor) for metastatic melanoma. At diagnosis of advanced melanoma, immunosuppressive therapy had been minimized in all but one. Adverse effects included one case of grade 1 diarrhea and one grade 1 pruritus. One patient had acute T-cell-mediated rejection confirmed by histology, after the first injection of ipilimumab. After a median follow-up of 4.5 (3-20) months, one patient achieved partial response, one had stable disease and four had disease progression. All the patients died, 5 from melanoma, 1 from another cause. In this series and in the literature, ipilimumab proves to be safe and possibly active. The acute rejection we encountered was probably related to both a rapid, drastic reduction of immunosuppression and to the use of ipilimumab. Our safety data on ipilimumab contrasts with the organ transplant rejections already reported with PD-1 inhibitors. We consider that immunosuppression should not be minimized, as the impact on metastatic disease control is probably small. This article is protected by copyright. All rights reserved.
PMID: 30107088 [PubMed – as supplied by publisher]