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Sirolimus use in solid-organ transplant recipients lowered risk of subsequent skin cancer

Solid-organ transplant recipients who took sirolimus after developing posttransplant cancer had a lower risk for subsequent skin cancer, according to recent study results published in JAMA Dermatology.

Researchers conducted a retrospective cohort study from 2000 through 2008 at two academic tertiary care centers. They reviewed electronic medical records for solid-organ transplant recipients (OTRs) diagnosed with posttransplant cancer and to identify the organ transplanted, pretransplant and posttransplant cancers and immunosuppressive medications.”

At completion of follow-up, data were collected, which were then analyzed between April 20, 2013 and Oct. 4, 2014.

There were 329 OTRs with an index posttransplant cancer (229 men; mean age, 56 years), including 53.8% who underwent renal transplant; 17.6%, heart transplant; 16.4%, lung transplant; 10.3%, liver transplant; and 1.8%, mixed-organ transplant.

Ninety-seven OTRs (29.5%) underwent sirolimus therapy after diagnosis. Second posttransplant cancers developed among 130 OTRs (39.5%), including 115 cases of skin cancer.

There was an 11.6% reduction in risk for skin cancer among those treated with sirolimus vs. those who did not receive the treatment (26.8% vs. 38.4%; P = .045). There was also a reduced risk among nonrenal OTRs only (23.5% vs. 39.3%), but this was not significant.

History of pretransplant skin cancer, skin cancer as the index posttransplant cancer and sirolimus treatment were independent predictors of skin cancer formation.

The sirolumus and nonsirolimus treated cohorts displayed no significant difference in allograft rejection or death.

“In this mixed-organ cohort of OTRs, patients taking sirolimus after developing posttransplant skin cancer had a lower risk of developing subsequent skin cancer with no increased risk for overall mortality,” the researchers concluded. “Gradual conversion to a low-dose [mammalian target of rapamycin]-based regimen may be considered in patients who develop multiple or high-risk skin cancers to decrease their skin cancer burden. Further studies are needed to define optimal conversion regimens and dosing in such scenarios.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.