Balancing Efficacy and Safety: Immune Checkpoint Inhibitors in Solid Organ Transplant Recipients with Advanced Cancers

Introduction and Clinical Context

Immune checkpoint inhibitors (ICIs), including agents targeting programmed cell death protein-1 (PD-1) and its ligand (PD-L1), have revolutionized oncology by significantly improving survival outcomes in various advanced-stage cancers. However, their use in solid organ transplant recipients (SOTRs) presents a unique challenge: the potential for immune-mediated transplant rejection. SOTRs are inherently immunosuppressed to prevent allograft rejection, yet ICIs activate T-cell responses that may jeopardize graft survival.

This clinical dilemma has led to limited data and clinical uncertainty regarding the safety and efficacy of ICIs in this vulnerable population. Patients with a prior transplant who develop advanced cancers often face few effective options due to limited treatment choices, underscoring the importance of understanding the risk-benefit profile of ICIs in this setting.