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Alter, M; Satzger, I; Schrem, H; Kaltenborn, A; Kapp, A; Gutzmer, R.
Non-melanoma skin cancer is reduced after switch of immunosuppression to mTOR-inhibitors in organ transplant recipients.
J Dtsch Dermatol Ges. 2014; 12(6): 480-488. Doi: 10.1111/ddg.12355
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Co-authors Med Uni Graz: Schrem Harald Heinrich
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Abstract:: Organ transplant recipients are prone to the development of non-melanoma skin cancer. Organ transplant recipients often develop multiple non-melanoma skin cancers and the tumors show an aggressive growth pattern, therefore surgical therapy can be difficult. Switch of the immunosuppressive regimen to mTOR-inhibitors such as everolimus or sirolimus can have an antitumor effect. In a monocentric retrospective study we evaluated organ transplant recipients who presented with non-melanoma skin cancer in the years 2008-2010. Experience with patients who were switched to an mTOR-inhibitor due to non-melanoma skin cancer are reported in detail, and recent clinical studies are reviewed. 60 organ transplant recipients with non-melanoma skin cancer were evaluated. Due to the development of multiple non-melanoma skin cancer within a few years, the immunosuppressive regimen was switched to everolimus in 7 patients and to sirolimus in 5 patients. Eight patients were evaluable for the effect of mTOR-inhibitors on the development of non-melanoma skin cancer; 4 patients had to discontinue the medication with mTOR-inhibitors early due to various side effects. In the year before the switch to mTOR-inhibitors, 8 patients developed 16 squamous cell carcinomas, 3 Basal cell carcinomas and 22 cases of Bowen's disease. All tumors were histologically confirmed. In the year after switch of immunosuppression, the rate of squamous cell carcinomas (n = 2) and Bowen's disease (n = 3), but not of basal cell carcinomas (n = 2) was significantly reduced. Moreover, 5 prospective randomized trials recently have demonstrated a reduced number of non-melanoma skin cancers in organ transplant recipients after switch of the immunosuppressive regimen to mTOR-inhibitors. Switch of the immunosuppressive regimen to mTOR-inhibitors should be considered for organ transplant recipients suffering from multiple non-melanoma skin cancers. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.
Find related publications in this database (using NLM MeSH Indexing): Aged -; Bowen's Disease - diagnosis; Bowen's Disease - prevention & control; Carcinoma, Basal Cell - diagnosis; Carcinoma, Basal Cell - prevention & control; Drug Substitution -; Everolimus -; Female -; Humans -; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Male -; Middle Aged -; Organ Transplantation -; Postoperative Complications - diagnosis; Postoperative Complications - prevention & control; Randomized Controlled Trials as Topic -; Retrospective Studies -; Sirolimus - adverse effects; Sirolimus - analogs & derivatives; Sirolimus - therapeutic use; Skin Neoplasms - diagnosis; Skin Neoplasms - prevention & control