title: Non-melanoma skin cancer is reduced after switch of immunosuppression to mTOR-inhibitors in organ transplant recipients.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  Switch of the immunosuppressive regimen to mTOR-inhibitors should be considered for organ transplant recipients suffering from multiple non-melanoma skin cancers.
authors.affiliation: Department of Dermatology and Venerology, Otto von Guericke University, Magdeburg, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Alter
authors.forename: Imke
authors.initials: I
authors.lastname: Satzger
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaltenborn
authors.forename: Alexander
authors.initials: A
authors.lastname: Kapp
authors.forename: Ralf
authors.initials: R
authors.lastname: Gutzmer
mesh_terms: D000368:Aged; D001913:Bowen's Disease / Q000175:diagnosis / Q000517:prevention & control*; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000517:prevention & control*; D057915:Drug Substitution; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus