Checkpoint inhibitor therapy for cancer in solid organ transplantation recipients: an institutional experience and a systematic review of the literature

Table 1 Patient Demographic and Baseline Characteristics (n = 39)^a

Patient characteristic	No. (%)
Median age (range)	63 years (14–79 years)
Sex
Male	29 (74)
Female	10 (26)
Current cancer
Metastatic melanoma	24 (62)
Cutaneous squamous cell carcinoma	6 (15)
Non-small cell lung cancer	3 (8)
Hepatocellular carcinoma	4 (10)
Duodenal adenocarcinoma	1 (3)
Malignant peripheral nerve sheath tumor-like melanoma	1 (3)
Checkpoint inhibitor
Ipilimumab	14 (36)
Anti-PD-1 agents^b	30 (77)
Nivolumab	14 (36)
Pembrolizumab	17 (44)
Combined use of ipilimumab and nivolumab	1 (3)
Prior solid organ transplantation
Renal	23 (59)
Hepatic	11 (28)
Cardiac	5 (13)
Allograft rejection before initiation of checkpoint inhibitor therapy (n = 24)^c	4 (17)
Time between transplantation and initiation of checkpoint inhibitor therapy, median (range)	9 years (0.92–32 years)
Pre-emptive modification of the baseline immunosuppressive regimen at initiation of checkpoint inhibitor therapy^d	20 (51)
Concomitant immunosuppressive therapy at initiation of checkpoint inhibitor therapy^e
Corticosteroid	23 (59)
mTOR inhibitor (sirolimus, everolimus)	11 (28)
Calcineurin inhibitor (tacrolimus, cyclosporine)	19 (49)
Other immunosuppressive therapies (azathioprine, mycophenolate mofetil)	6 (15)
No treatment	1 (3)

^aAbbreviations: mTOR, mechanistic target of rapamycin; anti-PD-1, anti-programmed death-1. Some percentages may not add up to 100 owing to rounding
^bSix patients switched to anti-PD-1 agents after progression with ipilimumab alone (three switched to pembrolizumab, two switched to nivolumab, and one initially switched to pembrolizumab but was unable to tolerate treatment because of severe constitutional symptoms and later switched to nivolumab)
^cIn 15 patients identified from the literature, it was not reported whether the patient had previous episodes of allograft rejection after transplantation and before the start of checkpoint inhibitor therapy
^dIn two patients, modification of the baseline immunosuppressive regimen was reported before the second checkpoint inhibitor treatment dose
^eSeventeen patients were receiving combination immunosuppressive therapies at initiation of checkpoint inhibitors