20 Jan Transplantation Patients With Skin Cancer: Fewer New Tumors With Sirolimus
Medical Research: What is the background for this study?
Response: Several recent studies have shown a reduced incidence of skin cancer in organ transplant recipients (OTR) treated with sirolimus as first-time therapy and those converted from calcineurin inhibitors to sirolimus. Although cancer formation is one of the main reasons for conversion to sirolimus, studies examining the effect of sirolimus on the risk of subsequent cancer formation in organ transplant recipients who have already been diagnosed with a post-transplant cancer are limited.
Medical Research: What are the main findings?
Response: We conducted a study to assess the risk for subsequent cancer in a mixed-organ cohort of organ transplant recipients diagnosed with various post-transplant malignancies and compared subsequent cancer risk by sirolimus use. The results showed that 39.5% of patients developed a second post-transplant cancer-most were skin cancers (88.5%). Therefore, only factors associated with subsequent skin cancer formation could be determined. On multivariate analysis, patients with a history of skin cancer (before or after transplant) had a 2- to 5-fold higher risk for subsequent skin cancer and the use of sirolimus was protective, with a 40% skin cancer risk reduction in the overall cohort. When multivariate analysis was limited to non-renal OTRs (44.4% of the cohort), the same independent predictors were associated with subsequent skin cancer formation. No increase in rejection or mortality was associated with sirolimus use in the overall cohort.
Medical Research: What should clinicians and patients take away from your report?
Response: Dermatologists and transplant physicians should coordinate regular post-transplant surveillance of skin cancers in organ transplant recipients, particularly those with a history of skin cancer, and have close communication as skin cancers form to consider reduction in immunosuppressive therapy. Gradual conversion to sirolimus therapy may be considered in OTRs who develop cancer if the risk of skin cancer is of concern.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Further studies are needed to quantify sirolimus-associated risk reduction for other cancer types and to define optimal conversion regimens and dosing scenarios.
Karia PS, Azzi JR, Heher EC, Hills VM, Schmults CD. Association of Sirolimus Use With Risk for Skin Cancer in a Mixed-Organ Cohort of Solid-Organ Transplant Recipients With a History of Cancer. JAMA Dermatol.Published online January 20, 2016. doi:10.1001/jamadermatol.2015.5548.
Pritesh S. Karia, MPH (2016). Transplantation Patients With Skin Cancer: Fewer New Tumors With Sirolimus