Immune checkpoint inhibitors (ICIs) now represent standard-of-care options in refractory metastatic colorectal tumors with microsatellite instability (MSI) or mismatch repair deficiency caused by loss of or defective DNA mismatch repair proteins, such as MLH1, MSH2, MSH6, and PMS2.1,2 However, most large, prospective clinical trials investigating checkpoint blockade in MSI metastatic colorectal cancer (mCRC) have excluded patients who received a liver transplant.1,3 The safety and efficacy of ICIs in patients with cancer and solid organ transplants remain unclear given the possibility of graft rejection. This report presents the first case, to our knowledge, of a liver transplant recipient who developed mCRC with MSI and was safely and effectively treated with an ICI. We also review the literature on immunotherapy use in patients with other metastatic solid tumors after liver transplant and those with baseline liver function abnormalities.
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)| false . , Horvat TZ , Adel NG , Dang TO Immune-related adverse events, need for systemic immunosuppression, and effects on survival and time to treatment failure in patients with melanoma treated with ipilimumab at Memorial Sloan Kettering Cancer Center. 2015; 33: 3193– 3198. 10.1200/JCO.2015.60.8448 26282644
KEYTRUDA (pembrolizumab) [package insert]. Whitehouse Station NJ: Merck Sharp & Dohme Corp; 2018.
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