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[Concomitant use of nivolumab and immunosuppressants in a renal transplant patient].
Rev Mal Respir 2019; 36(9):1064-1068RM

Abstract

INTRODUCTION

Immune-checkpoint inhibitors have been approved for first and second line treatments of metastatic non-small cell lung cancer based on the results of several phase III trials. Patients with organ transplantation were excluded from these studies because checkpoint inhibitors could activate allo-reactive T cells leading to acute graft rejection.

CASE REPORT

A 71-year-old Caucasian-male was diagnosed with stage IV pulmonary adenocarcinoma with multiple metastases, without molecular alteration and negative PD-L1 status. He had a left kidney transplant, and his immunosuppressive regimen consisted of sirolimus and mycophenolate mofetil. After failure of two therapeutic lines (carboplatin-paclitaxel and erlotinib) a multidisciplinary oncology meeting with the nephrologist started third line treatment with nivolumab 3mg/kg every 15 days, with no modification of the immunosuppressive treatment. The patient received a total of 14 injections of nivolumab with stable disease but treatment was discontinued due to acute rejection of the transplanted kidney 6 months later, without need for dialysis. The patient died of a chylothorax related to progression of the tumour 12 months after initiation of nivolumab.

CONCLUSION

Immune checkpoint inhibitors are a potential treatment for solid organ transplant patients despite the risk of graft rejection.

Authors+Show Affiliations

Pôle pharmacie, CHU Grenoble Alpes, 38000 Grenoble, France; TIMC-IMAG UMR5525/ThEMAS, CNRS, université Grenoble Alpes, 38000 Grenoble, France. Electronic address: hpluchart@chu-grenoble.fr.Pôle thorax et vaisseaux, service hospitalo-universitaire de pneumologie et physiologie, CHU Grenoble Alpes, 38000 Grenoble, France.Département d'anatomie et cytologie pathologiques, Institut de Biologie et de Pathologie, CHU Grenoble Alpes, 38000 Grenoble, France.Pôle digestif-DUNE, clinique de néphrologie, CHU Grenoble Alpes, 38000 Grenoble, France.Pôle thorax et vaisseaux, service hospitalo-universitaire de pneumologie et physiologie, CHU Grenoble Alpes, 38000 Grenoble, France.Département d'anatomie et cytologie pathologiques, Institut de Biologie et de Pathologie, CHU Grenoble Alpes, 38000 Grenoble, France.Pôle thorax et vaisseaux, service hospitalo-universitaire de pneumologie et physiologie, CHU Grenoble Alpes, 38000 Grenoble, France; UGA/Inserm U1209/CNRS 5309, Institut pour l'avancée des biosciences, université Grenoble Alpes, 38000 Grenoble, France.Pôle thorax et vaisseaux, service hospitalo-universitaire de pneumologie et physiologie, CHU Grenoble Alpes, 38000 Grenoble, France; UGA/Inserm U1209/CNRS 5309, Institut pour l'avancée des biosciences, université Grenoble Alpes, 38000 Grenoble, France.Pôle thorax et vaisseaux, service hospitalo-universitaire de pneumologie et physiologie, CHU Grenoble Alpes, 38000 Grenoble, France; UGA/Inserm U1209/CNRS 5309, Institut pour l'avancée des biosciences, université Grenoble Alpes, 38000 Grenoble, France.

Pub Type(s)

English Abstract
Journal Article

Language

fre

PubMed ID

31611026

Citation

Pluchart, H, et al. "[Concomitant Use of Nivolumab and Immunosuppressants in a Renal Transplant Patient]." Revue Des Maladies Respiratoires, vol. 36, no. 9, 2019, pp. 1064-1068.
Pluchart H, Ferrer L, Giovannini D, et al. [Concomitant use of nivolumab and immunosuppressants in a renal transplant patient]. Rev Mal Respir. 2019;36(9):1064-1068.
Pluchart, H., Ferrer, L., Giovannini, D., Tetaz, R., Pinsolle, J., Stephanov, O., ... Toffart, A. C. (2019). [Concomitant use of nivolumab and immunosuppressants in a renal transplant patient]. Revue Des Maladies Respiratoires, 36(9), pp. 1064-1068. doi:10.1016/j.rmr.2019.08.004.
Pluchart H, et al. [Concomitant Use of Nivolumab and Immunosuppressants in a Renal Transplant Patient]. Rev Mal Respir. 2019;36(9):1064-1068. PubMed PMID: 31611026.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Concomitant use of nivolumab and immunosuppressants in a renal transplant patient]. AU - Pluchart,H, AU - Ferrer,L, AU - Giovannini,D, AU - Tetaz,R, AU - Pinsolle,J, AU - Stephanov,O, AU - Giaj Levra,M, AU - Moro-Sibilot,D, AU - Toffart,A-C, Y1 - 2019/10/12/ PY - 2019/06/28/received PY - 2019/08/07/accepted PY - 2019/10/16/pubmed PY - 2019/10/16/medline PY - 2019/10/16/entrez KW - Adenocarcinoma KW - Adénocarcinome KW - Graft rejection KW - Immune checkpoint inhibitor KW - Immuno-suppression KW - Immunosuppression thérapeutique KW - Immunothérapie KW - Rejet KW - Transplantation SP - 1064 EP - 1068 JF - Revue des maladies respiratoires JO - Rev Mal Respir VL - 36 IS - 9 N2 - INTRODUCTION: Immune-checkpoint inhibitors have been approved for first and second line treatments of metastatic non-small cell lung cancer based on the results of several phase III trials. Patients with organ transplantation were excluded from these studies because checkpoint inhibitors could activate allo-reactive T cells leading to acute graft rejection. CASE REPORT: A 71-year-old Caucasian-male was diagnosed with stage IV pulmonary adenocarcinoma with multiple metastases, without molecular alteration and negative PD-L1 status. He had a left kidney transplant, and his immunosuppressive regimen consisted of sirolimus and mycophenolate mofetil. After failure of two therapeutic lines (carboplatin-paclitaxel and erlotinib) a multidisciplinary oncology meeting with the nephrologist started third line treatment with nivolumab 3mg/kg every 15 days, with no modification of the immunosuppressive treatment. The patient received a total of 14 injections of nivolumab with stable disease but treatment was discontinued due to acute rejection of the transplanted kidney 6 months later, without need for dialysis. The patient died of a chylothorax related to progression of the tumour 12 months after initiation of nivolumab. CONCLUSION: Immune checkpoint inhibitors are a potential treatment for solid organ transplant patients despite the risk of graft rejection. SN - 1776-2588 UR - https://www.unboundmedicine.com/medline/citation/31611026/[Concomitant_use_of_nivolumab_and_immunosuppressants_in_a_renal_transplant_patient] L2 - https://linkinghub.elsevier.com/retrieve/pii/S0761-8425(19)30328-6 DB - PRIME DP - Unbound Medicine ER -