1
|
Van Meerhaeghe T, Baurain J, Bechter O, Orte Cano C, Del Marmol V, Devresse A, Doubel P, Hanssens M, Hellemans R, Lienard D, Rutten A, Sprangers B, Le Moine A, Aspeslagh S. Cemiplimab for advanced cutaneous squamous cell carcinoma in kidney transplant recipients. Front Nephrol 2022; 2:1041819. [PMID: 37675002 PMCID: PMC10479765 DOI: 10.3389/fneph.2022.1041819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/06/2022] [Indexed: 09/08/2023]
Abstract
Background Kidney transplant recipients (KTR) are at increased risk of cancer due to chronic immunosuppression. Non-melanoma skin cancer has an excess risk of approximately 250 times higher than the general population. Moreover, in solid organ transplant recipients (SOTR) these cancers have a more aggressive behavior, with an increased risk of metastasis and death. Cemiplimab, a human monoclonal IgG4 antibody against programmed cell death (PD-1) has shown considerable clinical activity in metastatic and locally advanced cutaneous squamous cell carcinoma (cSCC) in patients for whom no widely accepted standard of care exists. Cemiplimab has therefore been approved since 2018 for the treatment of advanced cSCC. However, data regarding the use of cemiplimab in SOTR and particularly in KTR are scarce and based on published case reports and small case series. In this study, we report on the real-life outcome of cemiplimab use in a Belgian cohort of seven KTR suffering from advanced cSCC. Objective To report on the overall response rate (ORR) and safety of cemiplimab in KTR in Belgium. Results Seven patients suffering from advanced cSCC, treated with cemiplimab, between 2018 and 2022, in Belgium were identified. Three patients were on corticosteroid monotherapy, one patient on tacrolimus monotherapy and three patients were on at least 2 immunosuppressants at start of cemiplimab. The ORR was 42.8%, stable disease was seen in 14.3% and progressive disease was found in 42.8% of the patients, respectively. The median administered number of cycles was 12, interquartile range (IQR) 25-75 [3.5 - 13.5]. All patients were treated with surgery before administration of cemiplimab, 71.4% received additional radiotherapy and only 1 patient was treated with chemotherapy prior to receiving cemiplimab. Biopsy-proven acute renal allograft rejection was observed in one patient, who eventually lost his graft function but showed a complete tumor response to treatment. Low grade skin toxicity was seen in one patient of the cohort. Conclusion The present case series shows that the use of cemiplimab in KTR with advanced cSCC who failed to respond to previous surgery, chemo - and/or radiotherapy treatment is associated with an ORR of 42.8% with minimal risk of graft rejection (14.3%) and good tolerance.
Collapse
Affiliation(s)
- T. Van Meerhaeghe
- Department of Nephrology, Hôpital Erasme – Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - J.F. Baurain
- Department of Oncology, Clinique Universitaire Saint-Luc – Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - O. Bechter
- Department of Oncology, Universitair Ziekenhuis (UZ) Leuven – Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - C. Orte Cano
- Department of Dermatology, Hôpital Erasme – Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V. Del Marmol
- Department of Dermatology, Hôpital Erasme – Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A. Devresse
- Department of Nephrology, Clinique Universitaire Saint-Luc – Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - P. Doubel
- Department of Nephrology, Academisch Ziekenhuis (AZ) Groeninge, Kortrijk, Belgium
| | - M. Hanssens
- Department of Oncology, Academisch Ziekenhuis (AZ) Groeninge, Kortrijk, Belgium
| | - R. Hellemans
- Departement of Nephrology, Universitair Ziekenhuis (UZ) Antwerpen, Antwerpen, Belgium
| | - D. Lienard
- Department of Dermatology, Hôpital Erasme – Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A. Rutten
- Department of Oncology, GasthuisZuster, Antwerpen, Belgium
| | - B. Sprangers
- Department of Nephrology, Universitair Ziekenhuis (UZ) Leuven – Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - A. Le Moine
- Department of Nephrology, Hôpital Erasme – Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S. Aspeslagh
- Department of Oncology, Universitair Ziekenhuis (UZ) Brussel – Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
2
|
Bernards J, Doubel P, Meeus G, Lerut E, Corveleyn A, Van Den Heuvel LP, Meersseman W, Kuypers DK, Claes KJ. Hyperhomocysteinemia: a trigger for complement-mediated TMA? Acta Clin Belg 2021; 76:65-69. [PMID: 31401947 DOI: 10.1080/17843286.2019.1649039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 34-year-old man of North African descent was referred to the emergency department because of malignant hypertension (220/113 mmHg), acute visual disturbances and acute kidney failure (serum creatinine 14.0 mg/dL). Blood analysis was compatible with thrombotic microangiopathy (TMA). Kidney biopsy confirmed this diagnosis with histological changes including intimal edema, arteriolar thrombi, and severe tubulointerstitial damage. Fundoscopy showed hypertensive retinopathy stage IV. Subsequent biochemical screening revealed normal complement testing and a marked elevation in homocysteine concentration (161 µmol/L; normal value 7-15 µmol/L). Other secondary causes of TMA were excluded. Further genetic testing for cobalamin C (cblC) deficiency showed no pathogenic mutations in the MMACHC gene. However, a homozygous c.665C>T polymorphism (NM_005957.4) in the methylenetetrahydrofolate reductase (MTHFR) gene was found explaining the severe hyperhomocysteinemia due to reduced activity of MTHFR. Additional genetic testing for alternative complement pathway proteins showed mutations in the genes encoding factor H and factor B, both categorized as possibly pathogenic using mutation prediction software. This is the first described case of TMA in a patient with severe hyperhomocysteinemia caused by a genetic defect other than cblC. We postulate that endothelial damage due to hyperhomocysteinemia and hypertension could have triggered the TMA episode in this patient with two possible predisposing pathogenic mutations in the alternative complement pathway. Furthermore, our case demonstrates the need for complete full diagnostic testing in patients with TMA.
Collapse
Affiliation(s)
- J Bernards
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - P Doubel
- Department of Nephrology, AZ Groeninge Hospital, Kortrijk, Belgium
| | - G Meeus
- Department of Nephrology, AZ Groeninge Hospital, Kortrijk, Belgium
| | - E Lerut
- Department of Pathology, University Hospitals Leuven, Leuven
| | - A Corveleyn
- Department of Pediatric Nephrology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - L P Van Den Heuvel
- Department of Pediatric Nephrology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, Radboud UMC, Nijmegen, The Netherlands
| | - W Meersseman
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - D K Kuypers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology and Immunology, KU Leuven, University of Leuven, Leuven, Belgium
| | - KJ Claes
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology and Immunology, KU Leuven, University of Leuven, Leuven, Belgium
| |
Collapse
|
3
|
Ombelet S, Van Wijngaerden E, Lagrou K, Tousseyn T, Gheysens O, Droogne W, Doubel P, Kuypers D, Claes K. Mycobacterium genavenseinfection in a solid organ recipient: a diagnostic and therapeutic challenge. Transpl Infect Dis 2016; 18:125-31. [DOI: 10.1111/tid.12493] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/23/2015] [Accepted: 11/01/2015] [Indexed: 01/23/2023]
Affiliation(s)
- S. Ombelet
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| | - E. Van Wijngaerden
- Department of General Internal Medicine; University Hospitals Leuven; Leuven Belgium
| | - K. Lagrou
- Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - T. Tousseyn
- Department of Pathology; University Hospitals Leuven; Leuven Belgium
| | - O. Gheysens
- Department of Nuclear Medicine; University Hospitals Leuven; Leuven Belgium
| | - W. Droogne
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
| | - P. Doubel
- Department of Nephrology; AZ Groeninge; Kortrijk Belgium
| | - D. Kuypers
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| | - K.J. Claes
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| |
Collapse
|
4
|
Abstract
We present two cases of a bronchopulmonary tumor with paraneoplastic nephrotic syndrome as initial manifestation. After surgical resection of the tumor, regression of the nephrotic syndrome occurred.
Collapse
Affiliation(s)
- M. Malinowska
- Departments of Vascular and Thoracic Surgery, AZ Groeninge, Kortrijk, Belgium
| | - P. Doubel
- Nephrology, AZ Groeninge, Kortrijk, Belgium
| | - B. Gheysens
- Pulmonology, AZ Groeninge, Kortrijk, Belgium
| | - H. Ceuppens
- Departments of Vascular and Thoracic Surgery, AZ Groeninge, Kortrijk, Belgium
| |
Collapse
|
5
|
Van Moerkercke W, Verhamme M, Doubel P, Meeus G, Oyen R, Van Steenbergen W. Autoimmune pancreatitis and extrapancreatic manifestations of IgG4-related sclerosing disease. Acta Gastroenterol Belg 2010; 73:239-246. [PMID: 20690563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In a review of the literature concerning autoimmune pancreatitis we had special interest for the concept of IgG4-related pathology as a systemic disease with several clinical manifestations. In general, IgG4-positivity can not only be found in the pancreas, but also at the level of the kidneys, extrahepatic biliary ducts, gallbladder, lungs, salivary glands, lacrimal glands, retroperitoneal tissue, ureters, prostate, meninges and lymph nodes. IgG4 seems to be a central key player in the pathophysiology of this disease.
Collapse
Affiliation(s)
- W Van Moerkercke
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|