Kwatra, Vineet; Karanth, Narayan; Priyadarshana, Kelum; Charakidis, Michail

Author(s)

Kwatra, Vineet

Karanth, Narayan

Priyadarshana, Kelum

Charakidis, Michail

Publication Date

2017-03-19

Abstract

Transplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma. The efficacy and toxicity profiles of checkpoint inhibitors in this cohort of patients are not well described. To the best of our knowledge, this is the first case report of a renal transplant patient with stage IV melanoma treated with a programmed cell death protein 1 checkpoint inhibitor that led to both treatment failure and renal graft rejection. We present a case of a 58-year-old white man with a long-standing cadaveric renal transplant who was diagnosed with a B-Raf Proto-Oncogene, Serine/Threonine Kinase wild-type metastatic melanoma. He was treated with first-line pembrolizumab but experienced subsequent graft failure and rapid disease progression. This case highlights the risks associated with the administration of checkpoint inhibitors in patients with a renal transplant and on immunosuppressive therapy. More specifically, it adds to the literature indicating that, compared with the cytotoxic T-lymphocyte-associated protein 4 inhibitor ipilimumab, anti-programmed cell death protein 1 agents are more likely to lead to renal graft failure. Additionally, these novel immunotherapeutics may be ineffective in transplant patients; therefore, clinicians should be very aware of those risks and carefully consider selection of agents and full disclosure of the risks to their patients.

Citation

J Med Case Rep . 2017 Mar 19;11(1):73. doi: 10.1186/s13256-017-1229-z.

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/28315636/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/5264

Subject

Case report

Checkpoint inhibitors

Melanoma

Toxicity

Transplant

MESH subject

Antibodies, Monoclonal

Antibodies, Monoclonal, Humanized

Antineoplastic Agents

Fatal Outcome

Graft Rejection

Humans

Immunosuppressive Agents

Ipilimumab

Kidney Failure, Chronic

Kidney Transplantation

Male

Melanoma

Middle Aged

Programmed Cell Death 1 Receptor

Proto-Oncogene Proteins B-raf

Skin Neoplasms

Treatment Failure

Title

Pembrolizumab for metastatic melanoma in a renal allograft recipient with subsequent graft rejection and treatment response failure: a case report.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Kwatra, Vineet Karanth, Narayan Priyadarshana, Kelum Charakidis, Michail
Publication Date	2017-03-19
Abstract	Transplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma. The efficacy and toxicity profiles of checkpoint inhibitors in this cohort of patients are not well described. To the best of our knowledge, this is the first case report of a renal transplant patient with stage IV melanoma treated with a programmed cell death protein 1 checkpoint inhibitor that led to both treatment failure and renal graft rejection. We present a case of a 58-year-old white man with a long-standing cadaveric renal transplant who was diagnosed with a B-Raf Proto-Oncogene, Serine/Threonine Kinase wild-type metastatic melanoma. He was treated with first-line pembrolizumab but experienced subsequent graft failure and rapid disease progression. This case highlights the risks associated with the administration of checkpoint inhibitors in patients with a renal transplant and on immunosuppressive therapy. More specifically, it adds to the literature indicating that, compared with the cytotoxic T-lymphocyte-associated protein 4 inhibitor ipilimumab, anti-programmed cell death protein 1 agents are more likely to lead to renal graft failure. Additionally, these novel immunotherapeutics may be ineffective in transplant patients; therefore, clinicians should be very aware of those risks and carefully consider selection of agents and full disclosure of the risks to their patients.
Citation	J Med Case Rep . 2017 Mar 19;11(1):73. doi: 10.1186/s13256-017-1229-z.
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/28315636/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/5264
Subject	Case report Checkpoint inhibitors Melanoma Toxicity Transplant
MESH subject	Antibodies, Monoclonal Antibodies, Monoclonal, Humanized Antineoplastic Agents Fatal Outcome Graft Rejection Humans Immunosuppressive Agents Ipilimumab Kidney Failure, Chronic Kidney Transplantation Male Melanoma Middle Aged Programmed Cell Death 1 Receptor Proto-Oncogene Proteins B-raf Skin Neoplasms Treatment Failure
Title	Pembrolizumab for metastatic melanoma in a renal allograft recipient with subsequent graft rejection and treatment response failure: a case report.
Type of document	Journal Article
Entity Type	Publication

Pembrolizumab for metastatic melanoma in a renal allograft recipient with subsequent graft rejection and treatment response failure: a case report.

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