Ciclosporin withdrawal may reduce cancer risk
Withdrawing ciclosporin treatment in transplant patients reduces their risk of developing cancer, according to a study presented last week at the 12th Congress of the European
Society for Organ Transplantation in Geneva.
In the study, 430 renal transplant patients were randomised either to
continue receiving a combination of sirolimus (Rapamune) and
ciclosporin, or have ciclosporin withdrawn and receive ongoing sirolimus
for three months after transplantation. Five-year data show 19 of the
sirolimus and ciclosporin group developed non-skin malignancies (including
cancers of the lung, oropharynx, kidney, gastrointestinal system, prostate,
breast, thyroid and cervix) compared with seven of the sirolimus-alone
patients (P=0.015). In addition, graft survival was significantly better
for patients having ciclosporin withdrawn (P=0.024).
“This is the first prospective study showing withdrawing calcineurin
inhibitor ciclosporin leads to a reduced tumour incidence, without any
adverse
effects on rejection,” said chief investigator Joseph Campistol,
from the nephrology department at the University of Barcelona.
Further evidence showing detrimental carcinogenic effects for calcineurin
inhibitors is added by a study published in Transplantation (2005;80:883).
The retrospective analysis of more than 33,000 renal transplant patients
on the Organ Procurement and Transplant Network for Organ Sharing (OPTN/UNOS)
database, who received a renal transplant between 1996 and 2001, showed
0.6 per cent of patients treated with sirolimus or everolimus developed
new cancers, compared with 1.81 per cent receiving calcineurin inhibitors
(ciclosporin and tacrolimus [Prograf]) (P<0.001).
Dr Campistol told the meeting that guidelines were needed on the use
of immunosuppression agents both in patients with current cancer and
those with a past history of the disease. |
The
Pharmaceutical Journal
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