Non‐melanoma skin cancer is reduced after switch of immunosuppression to mTOR‐inhibitors in organ transplant recipients. (12th May 2014) - Alter, Mareike
Summary Background 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. Patients and Methods 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. Results 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. Conclusion Switch of the immunosuppressive regimen to mTOR‐inhibitors should be considered for organ transplant recipients suffering from multiple non‐melanoma skin cancers.