Ipilimumab Efficient in Kidney Transplantation Patients With Metastatic Melanoma

Ipilimumab Efficient in Kidney Transplantation Patients With Metastatic Melanoma

shutterstock_113697745In a study titled “Successful Administration of Ipilimumab to Two Kidney Transplantation Patients With Metastatic Melanoma, a team of researchers from Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, reported that ipilimumab was successfully administered to two patients suffering with metastatic melanoma, who had already received kidney transplantation.

Ipilimumab (Yervoy; Bristol-Myers Squibb) is an anti-CTLA-4 receptor antibody, which inhibits the connection of the receptor to its ligand and allows the patient’s immune system to recognize and destroy tumor cells, therefore increasing the naturally occurring immune response.

The U.S. Food and Drug Administration have approved this immunotherapeutic for the treatment of patients with metastatic melanoma. However, for patients who suffer from autoimmune disorders or receive organ transplantations, available therapeutic options are significantly reduced.

The first patient treated in this clinical study was a 72-year-old man who received kidney transplantation for end-stage kidney disease due to hypertension, and who 8 years later was diagnosed with a ≥ 8 mm ulcerated melanoma on his left chest. After receiving a left axillary node dissection, the patient was treated with surgery and radiotherapy. However, 3 years later he was diagnosed with an unresectable left chest wall metastases and a new liver lesion, and subsequently initiated ipilimumab treatment. “The patient tolerated therapy well and had decreased abnormal metabolic activity corresponding to subcutaneous soft tissue lesions in the left lateral and anterior chest and near resolution of the previously seen abnormal [18F]-fluorodeoxyglucose (FDG) uptake in the left lobe of the liver”, the authors write in their study.

The other patient was a 58-year-old man who received kidney transplantation for advanced kidney failure caused by polycystic kidney disease. Seven years after the transplant, he was found to have a 4.2 mm nodular melanoma on his forehead, which was later diagnosed as BRAF and C-KIT wild type. After wide local excision, superficial parotidectomy and right neck dissection, his melanoma was found to be present in four different lymph nodes, and one year later his cancer was found to be metastasized. He then initiated treatment with ipilimumab, which after the fourth dose was found to initiate disease regression in several areas, including a decrease in size and FDG avidity of multiple bilateral pulmonary lesions.

“Although further study in a larger patient cohort is required, these two cases illustrate that ipilimumab may be a safe and effective option for patients with metastatic melanoma who have previously undergone solid organ transplantation. This is of particular importance given that the incidence of melanoma is higher among solid organ transplantation patients than in the general population”, the authors conclude.

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