晚期皮肤鳞状细胞癌肾移植受者早期免疫治疗停药后的持久完全缓解：一例报告并文献复习
Durable complete response to early immunotherapy discontinuation in a kidney transplant recipient with advanced cutaneous squamous cell carcinoma: A case report and review of literature.
作者信息
Lu Ziyao, Afzal Muhammad, Shirai Keisuke
机构信息
Department of Medicine, Dartmouth Hitchcock Medical Center.
Section of Medical Oncology, Dartmouth Hitchcock Medical Center.
出版信息
Transpl Immunol. 2023 Dec;81:101932. doi: 10.1016/j.trim.2023.101932. Epub 2023 Sep 19.
BACKGROUND
The usage of immunotherapy to treat skin malignancies in transplant patients requires weighing the risk of acute organ transplant rejection with the potential reduction of antitumor efficacy by transplant immunosuppression. Reducing the duration of immune checkpoint inhibitor treatment may help prevent acute transplant rejection and late immune-related adverse events.
CASE PRESENTATION
An allogenic kidney transplant patient who developed regionally metastatic cutaneous squamous cell carcinoma received four cycles of pembrolizumab with complete response to therapy. Therapy was discontinued due to fatigue, significant cancer response, and to reduce the risk of acute graft rejection. His renal function remained stable, and he achieved subsequent durable response after treatment discontinuation.
CONCLUSION
Organ transplant recipients with complete response to immunotherapy for cutaneous squamous cell carcinoma may continue to respond despite early treatment cessation. This may reduce the risks of late immune-related adverse events and acute graft rejection.
背景
在移植患者中使用免疫疗法治疗皮肤恶性肿瘤，需要权衡急性器官移植排斥反应的风险与移植免疫抑制可能降低抗肿瘤疗效的问题。缩短免疫检查点抑制剂治疗的持续时间可能有助于预防急性移植排斥反应和晚期免疫相关不良事件。
病例介绍
一名发生局部转移性皮肤鳞状细胞癌的同种异体肾移植患者接受了四个周期的帕博利珠单抗治疗，治疗取得完全缓解。由于疲劳、显著的癌症缓解以及为降低急性移植物排斥反应的风险，治疗中断。他的肾功能保持稳定，在治疗中断后实现了后续的持久缓解。
结论
对皮肤鳞状细胞癌免疫疗法有完全反应的器官移植受者，即使早期停止治疗也可能继续有反应。这可能会降低晚期免疫相关不良事件和急性移植物排斥反应的风险。
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