Change is good.

Top Line: Not all post-organ transplant immunosuppressants are created equal when it comes to skin cancer risk.
The Study: If you develop a skin cancer after organ transplantation, your chances of a second skin cancer within the next 3 years are as high as 4 in 5. The French phase 3 TUMORAPA trial enrolled 120 kidney transplant recipients who developed a cutaneous malignancy while on a calcineurin inhibitor (e.g., cyclosporin). They were then randomized them to continuation of the calcineurin inhibitor versus a change to sirolimus (an mTOR inhibitor) with a primary endpoint of life free of cutaneous squamous cell carcinoma (cSCC). If you’re thinking that’s a small n, remember that differences in outcomes are made clear based on number of events not number of enrollees. And boy was a difference seen. Rates of cSCC-free survival at 5 years for those switched to sirolimus → not switched were 59% → 22%, and rates of survival free of any skin cancer were 66% → 34% with no difference in graft outcomes.
Bottom Line: If you’re treating immunosuppressed patients for skin cancer, check if they’ve talked with their transplant physician about switching to an mTOR inhibitor like sirolimus. | Dantal, J Clin Oncol 2018


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