Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania.
JAMA Dermatol. 2015 Jan;151(1):70-2. doi: 10.1001/jamadermatol.2014.1894.
Immunosuppressed patients with solid organ transplants have an increased risk for nonmelanoma skin cancer. Vismodegib has been reported to be effective for select locally advanced or metastatic basal cell carcinomas. However, there is no data documenting the use and safety of vismodegib in immunosuppressed organ transplant patients.
We describe a 78-year-old white man with a history of orthotopic heart transplant, immunosuppressed with low-dose cyclosporine, who presented to a specialty dermatology transplant clinic with multiple, recurrent, locally aggressive facial basal cell carcinomas. Through a multidisciplinary approach, the patient was started on vismodegib therapy. The pharmacokinetics of cyclosporine in the setting of vismodegib administration and weekly monitoring of cyclosporine levels ensured that therapeutic immunosuppression levels were achieved without toxic effects.
To our knowledge, this is the first report that details vismodegib use in an immunosuppressed heart transplant patient receiving cyclosporine therapy. With a growing immunosuppressed organ transplant population at high risk for basal cell carcinoma, therapeutic options for locally advanced or metastatic disease are limited. Vismodegib appears to be a safe option for patients receiving cyclosporine therapy with routine monitoring. Future research is needed to evaluate the safety profile of vismodegib with other immunosuppressive agents.
接受实体器官移植的免疫抑制患者罹患非黑色素瘤皮肤癌的风险增加。已有报道称维莫德吉（vismodegib）对特定局部晚期或转移性基底细胞癌有效。然而，尚无数据记录维莫德吉在免疫抑制器官移植患者中的使用和安全性。
我们描述了一位 78 岁白人男性，有原位心脏移植史，接受低剂量环孢素免疫抑制治疗，因多发、复发性、局部侵袭性面部基底细胞癌而就诊于专门的皮肤科移植诊所。通过多学科方法，开始对患者使用维莫德吉治疗。维莫德吉给药时环孢素的药代动力学以及每周监测环孢素水平，确保实现了治疗性免疫抑制而无毒性作用。
据我们所知，这是首例详细报告维莫德吉在接受环孢素治疗的免疫抑制心脏移植患者中的使用情况。随着免疫抑制器官移植人群的增加，他们罹患基底细胞癌的风险很高，局部晚期或转移性疾病的治疗选择有限。维莫德吉似乎是接受环孢素治疗且常规监测的患者的安全选择。需要进一步研究来评估维莫德吉与其他免疫抑制药物的安全性概况。
