Immune checkpoint inhibitors use in lung transplant recipients: a case series and systematic review of literature

Abstract

Immune checkpoint inhibitors (ICIs) are an innovative treatment that has improved long-term survival in several neoplastic diseases over the past decade. Solid organ transplant (SOT) recipients, particularly lung transplant (LTx) recipients, have been largely excluded from clinical trials evaluating the safety and efficiency of ICIs, because of the perceived high risk of allograft rejection. In this study, we sought to evaluate the use of ICIs for all neoplastic diseases in LTx patients in all French LTx centers and two Belgian centers. We found only a limited number of cases in which ICIs were suggested to two patients due to a lack of alternative treatments. In the first case, acute respiratory failure and death occurred, whereas in the second case, ICI treatment was well tolerated and resulted in a partial response. In addition, we presented the case of a third LTx patient in whom the use of ICIs was considered but not used due to the patient's comorbidities. This last case highlights the difficulty of discussing the risk-benefit balance, which ultimately did not favor ICI treatment of this patient. Further multicenter randomized controlled trials are necessary to investigate the safety and efficacy of ICIs in LTx recipients.

Keywords: cancer; immune checkpoint inhibitors; lung transplant.

Figure 1

Chest computed tomography scan from Case 1 at the time of the episode of acute respiratory failure after immune checkpoint inhibitor initiation, showing diffuse interstitial lung opacities, with ground-glass opacities (A) and low-volume bilateral pleural effusion (B).

Figure 2

Summary of the course of history and treatment timeline for all three cases. cSCC, cutaneous squamous cell carcinoma; ICI, immune checkpoint inhibitor.