Dados do Trabalho

Título

CEMIPILIMAB AT LIVER TRANSPLANTATION RECIPIENT WITH ADVANCED SQUAMOUS CELL CARCINOMA: A CASE REPORT

Apresentação do caso

The patient was a 71-year-old male liver transplant recipient due to chronic hepatitis B virus infection and hepatic cirrhosis, who developed facial squamous cell carcinoma (SCC) four years after the transplantation. The SCC was primarily located on the face (nose and maxilla), and there was no evidence of metastatic disease. He underwent complete resection in 2005. Five years after there was local recurrence, and he was over again subjected to surgery, followed by adjuvant radiotherapy.The surgeries resulted in defacement of the patient who had eye socket exenterention, partial maxillectomy and masticatory commitment. At 2013 and 2018, new relapses occurred. Both was treated by platinum-based chemotherapy. First reached complete response and the second moment just partial response.In June 2020, there was locally progression and metastatic lung disease emerged. At this point the cemiplimabe, an anti-PD1 therapy, was approved in Brazil. In accordance with the transplantation team, the patient accepted the risks in front the life-threatening situation. Since the start of the therapy, the patient was regularly subjected to liver functional tests and mensal clinical evaluations. There was no evidence of toxicities even grade 1 or 2, and no evidence of rejection during twelve months of treatment so far. Furthermore, the patient achieved complete response at the first radiologic assessment until now.

Discussão

Squamous-cell and basal-cell carcinomas are the most common skin cancer in transplant patients. It’s due to the lifelong immunosuppressive therapies. The incidence of squamous-cell increases in an exponential trend during the immunosuppression, and the disease appears to be more aggressive in this population. Cemiplimabe is an anti-PD1 therapy that demonstrated an antitumoral activity in advanced SCC. Because of the risk of rejection, the transplant recipients are commonly excluded from the trials. There is a lack of evidence about the safety of immunotherapy in these patients.There are some case reports about checkpoint inhibitors in kidney transplantation that demonstrated a higher risk of allograft rejection up to 39% that should not be underestimated.

Comentários finais

In opposite, the patient in report, never experienced any evidence of rejection, and demonstrated an excellent tolerance to the immunotherapy with no toxicities. This report evidences that checkpoint inhibitors may be a feasible treatment in selected cases of liver transplant recipient.

Palavras-chave

cemiplimabe, transplant, squamous cell carcinoma