19 Jan Cancer Killed While Preserving A Kidney Transplant
MedicalResearch.com Interview with:
Kenar D. Jhaveri, MD
Professor of Medicine
Division of Kidney Diseases and Hypertension
Hofstra Northwell School of Medicine,
100 Community Drive, Great Neck, NY 11021
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The immune check point inhibitors are novel anti cancer agents being used rapidly in various cancers. Many cancers don’t allow our natural immune system to attack the cancer. These immunotherapy agents “activate” the immune system to attack the cancer. These agents have been reported to cause multiple end organ side effects as noted by this recent NYT article. We also recently reported the known renal effects of immunotherapy.
In the kidney transplant patient who is on immunosuppressive agents, the physicians need to keep the immune system suppressed to preserve the kidney. When one of these agents are used for a cancer in a kidney transplant patient, prior reports have suggested severe rejection episodes and loss of the transplanted kidney. Our case in the NEJM is the first report of a preventive strategy used to allow for simultaneous treatment of cancer and preventive rejection of the kidney. We used a regimen of steroids and sirolimus( an anti-proliferative agent that is used to treat cancer and also is an immunosuppresant) along with the immunotherapy. The cancer started regressing and the kidney did not reject.
MedicalResearch.com: What should readers take away from your report?
Response: While many cases of transplant related cancers treated with immune check point inhibitors advanced to rejection, there might be role for prophylactic steroids and sirolimus to prevent rejection. This is a single case report and more data is needed to recommend this to all patients. We recently reviewed all the cases published in the use of immune check point inhibitors in another publication.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: There should be more research done in using the immunotherapies in patients who have cancer and an organ transplant( kidney, heart, liver) and also autoimmune diseases such as lupus. This will allow oncologists to have a protocol in using these very promising agents for cancer in more patients that need it.
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Preserved Renal-Allograft Function and the PD-1 Pathway Inhibitor Nivolumab
N Engl J Med 2017; 376:191-192January 12, 2017DOI: 10.1056/NEJMc1614298
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