The Bad and the Good News on Cancer Immunotherapy: Implications for Organ Transplant Recipients.

ABSTRACT

Cancer immunotherapy, especially the use of checkpoint inhibitors, is expanding and can be efficacious in organ transplant recipients with malignant neoplasia. In this review, we summarize clinical findings and evolution of several patients treated with CTL4-4 or PD-1 inhibitors reported in the literature. The CTL-4 inhibitor ipilimumab has been safely used in several liver and kidney allograft recipients. PD1-inhibitors look promising for tumor shrinking, but acute rejection is the rule, so they should be avoided in recipients of life-saving organs. Immunosuppression minimization, especially calcineurin inhibitor withdrawal is needed for adequate responses to checkpoint inhibitor treatments. The addition of sirolimus or everolimus may be helpful for mitigation rejections. The future will tell if selective boost of cancer-specific T-cell repertoire, possibly with the help of anticancer vaccines or adoptive T-cell transfer, will improve outcomes and decrease undesirable events.