Christine Ko, MD, professor of dermatology and pathology at Yale University, who specializes in transplant dermatology, explains the considerations involved with skin cancer–related treatment decisions among patients who’ve undergone a solid-organ or other type of organ transplant.
Good communication with all of the doctors on a patient's team, including transplant teams, can help to address treatment-related concerns, particularly those related to checkpoint inhibitor therapy and concerns surrounding potential organ rejection, noted Christine Ko, MD, professor of dermatology and pathology at Yale University.
What must clinicians consider when forming treatment plans for transplant patients who receive a skin cancer diagnosis?
I think that it’s a really important thing for me and for the patients to be able to have good communication among a team of doctors. I would never want to start any type of immunomodulatory/inhibitor type of medicine on a transplant patient without talking to the rest of the patient's transplant team. I wouldn't totally rule it out, but there's definitely literature out there that the transplant doctors and transplant pharmacists are very much aware of: that these immune inhibitors do lead to increased graft rejection, rejection of that transplanted organ. And patients don't want that, and of course neither do any of us as doctors.
There's a recent study in Journal of the American Academy of Dermatology, a nice analysis of what's in the literature so far, using things like checkpoint inhibitors in transplant patients. And they did show that this is a real concern, that the transplanted organ can be rejected and fail when you're put on a checkpoint inhibitor, or ipilimumab. There was about a 40% chance of that kind of rejection of the organ, and 14% of those patients did die from rejection, losing that key organ.
Another thing to keep in mind is that some of these cancers are quite advanced, and the majority of the patients treated with those medicines, you can get a sense that it was an attempt to really control the cancer, because the majority of the patients who died in that analysis died from the cancer, not from graft rejection.
I think sometimes in medicine we have these really tough decisions to make. I wouldn't say that you can't use those medicines—I have not had to use a medicine like that for skin cancer—but some of the patients certainly do have internal malignancies as well that can be quite advanced. It's something that just needs good communication among a really great team of doctors and, the most important, also patient input.