Pembrolizumab for metastatic melanoma in a renal allograft recipient with subsequent graft rejection and treatment response failure: a case report.
BACKGROUND
Transplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma. The efficacy and toxicity profiles of checkpoint inhibitors in this cohort of patients are not well described. To the best of our knowledge, this is the first case report of a renal transplant patient with stage IV melanoma treated with a programmed cell death protein 1 checkpoint inhibitor that led to both treatment failure and renal graft rejection.


METHODS
We present a case of a 58-year-old white man with a long-standing cadaveric renal transplant who was diagnosed with a B-Raf Proto-Oncogene, Serine/Threonine Kinase wild-type metastatic melanoma. He was treated with first-line pembrolizumab but experienced subsequent graft failure and rapid disease progression.


CONCLUSIONS
This case highlights the risks associated with the administration of checkpoint inhibitors in patients with a renal transplant and on immunosuppressive therapy. More specifically, it adds to the literature indicating that, compared with the cytotoxic T-lymphocyte-associated protein 4 inhibitor ipilimumab, anti-programmed cell death protein 1 agents are more likely to lead to renal graft failure. Additionally, these novel immunotherapeutics may be ineffective in transplant patients; therefore, clinicians should be very aware of those risks and carefully consider selection of agents and full disclosure of the risks to their patients.
Medical Oncology Department, Alan Walker Cancer Centre, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT, 0810, Australia. vkwatz@gmail.com.
Vineet
V
Kwatra
Medical Oncology Department, Alan Walker Cancer Centre, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT, 0810, Australia.
Narayan V
NV
Karanth
NT Renal Services, Royal Darwin Hospital, Darwin, NT, Australia.|Flinders University, Adelaide, SA, Australia.
Kelum
K
Priyadarshana
Medical Oncology Department, Alan Walker Cancer Centre, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT, 0810, Australia.
Michail
M
Charakidis
D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017809:Fatal Outcome; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D000074324:Ipilimumab; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008545:Melanoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors; D000090063:Proto-Oncogene Mas; D048493:Proto-Oncogene Proteins B-raf; D012878:Skin Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D017211:Treatment Failure
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000074324:Ipilimumab; C000715470:MAS1 protein, human; D061026:Programmed Cell Death 1 Receptor; D000090063:Proto-Oncogene Mas; C582435:pembrolizumab; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
Case report; Checkpoint inhibitors; Melanoma; Toxicity; Transplant