Systemic Therapy for Squamous Cell Carcinoma of the Skin in Organ Transplant Recipients

Abstract

During the second half of the 20th century, organ transplantation saved thousands of lives. This, unfortunately, also led to unforeseen consequences that need to be addressed to help extend the lives of patients who require these life-saving procedures. Secondary malignancies have been recognized as a potential consequence for decades. One of these malignancies, squamous cell carcinoma of the skin, not only appears more frequently in organ transplant recipients than the general population, but also is more aggressive in organ transplant recipients. It also shows a high propensity to nodal spread and metastasis in transplant patients. Unfortunately, there are no clear guidelines for a chemotherapy in this population, who have an increased need for alternative therapies to surgery given the high recurrence and metastasis rate. In this review, we attempt to describe the characteristics of squamous cell carcinoma of the skin in transplant recipients and discuss what chemotherapeutic options can be used to treat this aggressive malignancy.

Roles of the immune system in skin cancer

“…In large series, there is an estimated 65 to 250 fold increased incidence of cutaneous SCC and a 10 fold increased incidence of BCC in renal transplant recipients (RTRs) versus immunocompetent populations, and the risk is higher in men 23–26 . Skin cancers are also more aggressive in OTRs 27–29 , with a 3-year disease specific survival of 56% 30,31 and a metastasis rate of 7% compared to 0.25% in the general population 32 . Cutaneous cancer incidence may correspond to the degree of immunosuppression 20,25,33 , correlating with lower CD4 counts 34 , and the reduction of immunosuppression reduces the rate of initial and subsequent skin cancers 33,35 .…”

MicroRNA-125b Down-regulates Matrix Metallopeptidase 13 and Inhibits Cutaneous Squamous Cell Carcinoma Cell Proliferation, Migration, and Invasion

“…organ transplant recipients) represent a particular clinical problem. These tumor are often multiple and aggressive, with increased recurrences and metastasis (4). Metastatic cSCC often raise therapeutic problems, since chemotherapy is not consistently efficient (5).…”

Squamous cell carcinoma of neck metastasized to the lung and cervical lymph nodes, successfully treated with systemic docetaxel and local radiation therapy to the neck in a renal transplant patient

“…Takahiro ARITA, 1 Jun ASAI, 1 Maiko TAURA, 1 Makoto WADA, 1 Hideya TAKENAKA, 1 Aya MIYASHITA, 2 Norito KATOH 1…”

“…OTR have a high risk of SCC and metastasis compared with the general population. [1][2][3] Although metastatic SCC in OTR portends a poor prognosis, the role of chemoradiotherapy for metastatic SCC is unproven. We report a case of metastatic SCC, which was successfully treated with docetaxel and radiation therapy in a renal transplant patient.…”