In kidney-transplant patients with at least one cutaneous squamous-cell carcinoma, switching immunosuppressants (from calcineurin inhibitors to sirolimus) is associated with increased skin cancer-free survival and delayed development of new skin cancers, according to a study published in the New England Journal of Medicine. (2012;367:329-339).
Sylvie Euvrard, MD, of the Edouard Herriot Hospital Group in Lyon, France, and colleagues randomly assigned 120 kidney-transplant recipients who were receiving calcineurin inhibitors and had at least one cutaneous squamous-cell carcinoma to continue receiving calcineurin inhibitors (56 patients) or transition to sirolimus (64 patients).
At two years, the researchers found that the sirolimus group had significantly longer survival free of cutaneous squamous-cell carcinoma. New cutaneous squamous-cell carcinomas developed in fewer patients taking sirolimus (22% vs. 39%, which translated into a 44% reduction in relative risk) and after a significantly longer median interval (15 vs. seven months). Serious adverse events were more frequent in the sirolimus group, and these were twice as frequent in patients converted to sirolimus with rapid protocols compared with progressive protocols. Twenty-three percent of patients discontinued sirolimus due to adverse events. The researchers observed no graft rejections.
“In conclusion, in this study involving kidney-transplant recipients with at least one previous cutaneous squamous-cell carcinoma, conversion from calcineurin inhibitors to sirolimus was associated with a lower risk of subsequent skin cancers,” Dr. Euvrard and colleagues wrote.