Calcineurin inhibitors and rapamycin: cancer protection or promotion?
Since the introduction of cyclosporin A (CsA) in the early 1980s, the use of immunosuppressants has markedly increased. Already established drugs have proved effective in the treatment of a wide range of diseases outside transplantation medicine and new immunosuppressants have been developed for more specific indications such as psoriasis and atopic dermatitis. Patients in transplantation medicine as well as in dermatology have benefited significantly from systemic and topical application of both new and established drugs. But are these drugs without risks? Cancer-protecting effects have been reported for some of the available immunosuppressants. Conversely, other publications and the issue of a black box warning by the US Food and Drug Administration have increased concerns about cancer-promoting effects. Knowledge of the specific effects as well as adverse effects is paramount to ensure an application that is safe and beneficial for the patient. Here we review the mechanisms of action and therapeutic potential, and critically review recent literature with respect to possible carcinogenic side effects of systemic and topical CsA, tacrolimus, pimecrolimus and rapamycin.
Weischer
Maren
M
Department of Dermatology and Venerology, Eberhard Karls University, Liebermeisterstrasse 25, D-72076 Tuebingen, Germany.
Röcken
Martin
M
Berneburg
Mark
M
D065095:Calcineurin Inhibitors; D002273:Carcinogens / Q000633:toxicity*; D016572:Cyclosporine / Q000009:adverse effects / Q000494:pharmacology; D004260:DNA Repair; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000494:pharmacology; D008954:Models, Biological; D009369:Neoplasms / Q000209:etiology* / Q000517:prevention & control*; D011494:Protein Kinases / Q000187:drug effects; D020123:Sirolimus / Q000009:adverse effects* / Q000494:pharmacology*; D058570:TOR Serine-Threonine Kinases; D016559:Tacrolimus / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology; D014466:Ultraviolet Rays / Q000009:adverse effects
D065095:Calcineurin Inhibitors; D002273:Carcinogens; D007166:Immunosuppressive Agents; C117268:pimecrolimus; D016572:Cyclosporine; D011494:Protein Kinases; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus; D016559:Tacrolimus