#1693 Immunotherapy in kidney transplant patients with cancer: the latest challenge

Abstract

Abstract Background and Aims Cancer is one of the main causes of morbidity and mortality in kidney transplant (KT) patients. The use of immune checkpoint inhibitors (ICPIs) in these patients has been controversial because of the lack of robust evidence regarding their efficacy and safety. However, recent studies indicate that with and adequate management of the basal immunosuppression and a multidisciplinary approach in the follow-up of these patients, its use is feasible. Our study aims to describe our experience and results of using ICPIs in KT patients. Method Prospective study of KT patients with cancer who have received treatment with ICPIs. Before starting ICPIs treatment, according to our protocol, mycophenolate acid was discontinued, tacrolimus levels were reduced (to 4–6 ng/ml) and treatment with 5 mg of prednisone was maintained. Epidemiological, clinical and analytical data were collected, as well as immunological complications related to ICPIs treatment. Results Were included 6 patients, 66% male, mean age 63 +/− 7 years. Cancer's origin: 16% cutaneous, 50% bowel, 34% lung. All patients were in an advanced stage of cancer and had not responded to other treatments. Median creatinine level at the start of treatment: 125 µmol/L. Mean of baseline tacrolimus levels: 7.5 ng/ml. ICPIs used: 84% Pembrolizumab and 16% Atezolizumab. Mean follow-up time was 9 months. No episodes of rejection were observed. Any patient developed de novo DSA. 33% developed acute tubulointerstitial nephritis, which were treated with high doses of prednisone, resulting in a good response. Mean tacrolimus levels during treatment: 5.2 ng/ml. Median serum creatinine levels (at 1 m, 3 m, 6 m after KT): 138 µmol/L, 130 µmol/L and 146 µmol/L, respectively. 100% of patients had a very good oncological response. Mortality rate: 0%. One patient started dialysis 6 months after completing treatment, but he had poor renal function prior to the treatment. Conclusion Our results indicate that ICPIs can be appropriate treatments for KT patients with cancer, with acceptable complications on the renal allograft and very good oncological outcomes. Large studies are needed to confirm these results and optimize the management of immunosuppression in this context.