Clinical Report: Immune Checkpoint Inhibitors ‘High-Risk Yet Promising’ for Cancer Patients Who Undergo Organ Transplant

Overview

A meta-analysis involving over 2,600 cases indicates that immune checkpoint inhibitors (ICIs) present a high-risk yet promising treatment option for cancer patients who have undergone solid organ transplants. The study highlights varying rejection rates based on the type of ICI and transplanted organ.

Background

The use of immune checkpoint inhibitors has revolutionized cancer treatment, but their application in solid organ transplant recipients poses significant challenges due to the risk of transplant rejection. Understanding the balance between the therapeutic benefits of ICIs and the potential for allograft rejection is crucial for optimizing treatment protocols in this vulnerable patient population.

Data Highlights

Key Findings

• Rejection rates were highest in kidney transplant recipients (46.3%).
• Patients receiving anti-PD1 therapy had a rejection rate of 40.6%.
• Post-transplant ICI therapy resulted in a higher rejection rate (40.9%) compared to pre-transplant therapy (25.9%).
• Overall response rates varied by cancer type, with cutaneous squamous cell carcinoma showing the highest response rate (49.1%).
• Further research is needed to identify factors predicting outcomes in transplant recipients treated with ICIs.

Clinical Implications

Clinicians should carefully consider the type of immune checkpoint inhibitor and the timing of therapy in solid organ transplant recipients. Multidisciplinary management and thorough discussions regarding the risks of transplant rejection are essential when contemplating ICI therapy for these patients.

Conclusion

The findings underscore the need for cautious application of immune checkpoint inhibitors in solid organ transplant recipients, balancing potential oncologic benefits against the risk of allograft rejection.

References

1. Awidi M., Roswell Park Comprehensive Cancer Center, 2025 -- Immune Checkpoint Inhibitors ‘High-Risk Yet Promising’ for Cancer Patients Who Undergo Organ Transplant
2. the asco post — Meta-Analysis Reveals How ICIs May Impact Solid Organ Transplant Responses
3. the asco post — Are Immune Checkpoint Inhibitors Effective in Hospitalized Patients With Cancer?
4. The ASCO Post — RP1 Immunotherapy in Solid Organ Transplant Recipients With Skin Cancer
5. The ASCO Post — Study May Illuminate Cause of Common Checkpoint Inhibitor Adverse Effect
6. Meta-Analysis Reveals How ICIs May Impact Solid Organ Transplant Responses
7. Are Immune Checkpoint Inhibitors Effective in Hospitalized Patients With Cancer?
8. RP1 Immunotherapy in Solid Organ Transplant Recipients With Skin Cancer
9. Meta-Analysis Reveals How ICIs May Impact Solid Organ Transplant Responses - The ASCO Post
10. https://www.oregon.gov/oha/HPA/DSI-HERC/MembersOnly/7.9e%20NCCN%202.2025%20SCC.pdf
11. mTOR Inhibitor, Prednisone, and Cemiplimab for Kidney Transplant Recipients With Advanced Cutaneous Squamous Cell Carcinoma - The ASCO Post