Drug Reduces Cancer Risk in Organ Transplantation

Sirolimus reduces the risk of skin cancer for organ transplant recipients in certains situations, a recent study found.

The study, published in the Journal of the American Medical Association Dermatology, on January 20 was done by Pritesh S. Karia, MPH, of the Department of Dermatology at Brigham and Women’s Hospital at Harvard Medical School in Boston, Massachusetts, and colleagues.

The researchers began with the objective of comparing “skin cancer formation in a mixed-organ cohort of solid-organ transplant recipients (OTRs) who were or were not treated with sirolimus after developing a posttransplant index cancer of any type.” They began by examining the records at Brigham and Women’s Hospital and Massachusetts General Hospital “from January 1, 2000, to December 31, 2008, who were diagnosed as having a pathologically confirmed posttransplant cancer of any type.”

They reviewed the records of 329 patients who had kidney, heart, lung, or liver transplants, and those of 6 patients who’d undergone mixed-organ transplants, and who had “a pathologically confirmed posttransplant cancer of any type.” Of the 329 patients, 97 (29.5%) had been prescribed sirolimus, while 232 (70.5%) had not been. According to the authors, “the reasons for sirolimus therapy included posttransplant nonskin cancer (37 patients [28.1%]), improvement of allograft function and/or prevention of calcineurin inhibitor toxicity (30 patients [30.9%]), posttransplant skin cancer (28 patients [28.9%]), and unknown 92 patients [2.1%]).”

The researchers found that there was “a lower risk for skin cancer with sirolimus treatment,” based on the “cumulative incidence rates of skin cancer at 1,3, and 5 years after the index posttransplant cancer.” Although there were some limitations to the study, it shows that the use of a low-dose, mammalian target of rapamycin (mTOR)-based regimen “may be considered in patients who develop multiple or high-risk skin cancers to decrease their skin cancer burden.” They suggest that more studies are necessary to “define optimal conversion regimens and dosing in such scenarios.”