Triple Drug Combination Mitigates Kidney Rejection in Cancer Patients

A novel drug combination shows the potential to prevent kidney rejection in transplant patients undergoing cancer treatment.

The use of immune checkpoint inhibitors (PD-1), which activate the immune system to attack cancer cells, is increasing in popularity. Although the treatment has demonstrated efficacy in most cancer patients, it is much less successful in those who received a kidney transplant. If the immune system is activated in transplant patients, it causes the body to reject the donor kidney.

In a study published in the New England Journal of Medicine, investigators found that the combination of steroids and the immunosuppressant sirolimus could prevent organ transplant rejection during cancer treatment with PD-1 inhibitors.

The investigators observed the novel treatment in a 70-year-old Caucasian male who received a kidney transplant in 2010, and who recently underwent treatment for small bowel cancer that metastasized to the liver.

Prior to incorporating the PD-1 inhibitor nivolumab (Opdivo), the patient was administered the steroid prednisone, and sirolimus. The results of the study showed the combination treatment mitigated kidney transplant rejection, and the cancer regressed. Furthermore, the patient received full benefit from the immunotherapy without effecting the transplanted organ.

“In reviewing this patient’s case, I think we might have found a novel strategy of using pre-emptive steroids and sirolimus to mitigate organ rejection in transplant patients receiving cancer treatment involving PD-1 inhibitors,” said Dr Kenar D. Jhaveri, MD. “This letter highlights the use of a novel regimen and may give the patients with a kidney transplant and cancer hope of treating the cancer while keeping the kidney and thereby avoiding dialysis.”

The findings show promise for individuals undergoing cancer therapy who have also had a kidney transplant, according to the authors.

“Important discoveries begin with a novel observation,” said Kevin J. Tracey, MD, president and CEO of the Feinstein Institute. “I hope that the medical science community now will build on Dr Jhaveri’s discovery so that patients with cancer who must also undergo a kidney transplant can benefit.