A Report on the Safety of Acitretin Use in Renal Failure Patients on Hemodialysis.

Acitretin, commonly used for severe psoriasis and keratinocyte carcinoma chemoprevention in high-risk patients, is contraindicated in patients with end stage renal disease on hemodialysis. However, these patients often lack medication choices and in certain clinical scenarios, the benefits of acitretin may outweigh the potential risks. We identified 24 end stage renal disease patients on HD taking acitretin from Duke and Vanderbilt University Medical Centers. While adverse effects were common, patients did not frequently discontinue the medication due to them. We also found no association between acitretin with hospital admissions or mortality. We lastly found statistically significant increases in ALP and total bilirubin when on acitretin and dialysis compared to baseline. However, there was no dose-dependency or temporal association with acitretin or hemodialysis initiation. Based off these preliminary findings, we find that acitretin may safely be used in patients receiving HD with close monitoring of ALP and bilirubin.

Therapeutic Responses to Combination Nivolumab and Temozolomide as Salvage Therapy for Metastatic Melanoma: A Case Series.

The management of metastatic melanoma patients that fail multiple lines of systemic therapy remains a significant challenge. There is limited literature regarding combination of anti-PD-1 and temozolomide, or of other chemotherapy agents, in melanoma. Here, we present a series of 3 patients with metastatic melanoma and their responses to nivolumab and temozolomide combination therapy after progression on several local/regional therapies, combination immune checkpoint inhibitors, and/or targeted therapies. The novel combinatory strategy led to remarkable responses in all 3 patients shortly after initiating treatment with tumor remission and symptomatic improvement. The first patient has had ongoing response 15 months after initiating treatment, although he has since discontinued temozolomide due to intolerance. The remaining 2 patients show ongoing response after 4 months, with good tolerability. This case series suggests that nivolumab and temozolomide may be a promising option in the setting of advanced melanoma refractory to standard treatments, and warrants further investigation in larger series.