Sirolimus reduces cancer risk in kidney transplant
Early replacement of ciclosporin with the mTOR (molecular target of rapamycin) inhibitor sirolimus more than halves the risk of cancer in kidney transplant recipients, a study published in the Journal
of the American Society of Nephrology has revealed (2006;17:581).
Three months after renal transplantation, the 430 study patients were
randomly assigned to remain on an immunosuppressant regimen of ciclosporin,
sirolimus and steroids or have ciclosporin withdrawn and receive high-dose
sirolimus and steroids.
At five years, the median time to first skin carcinoma was delayed in
the sirolimus group (1,126 days versus 491 days in the ciclosporin group;
P=0.007), and the incidence of non-skin cancer was reduced (4.0 per cent
versus 9.6 per cent in the ciclosporin group; P=0.03).
Commenting, Alan Jardine, consultant nephrologist, Western Infirmary,
Glasgow, said: “Although immunosuppressive agents have undoubtedly
improved the quality of life for many organ recipients, it is widely
accepted that they can also increase malignancy risk. Cancer is now the
second most common cause of premature death in kidney recipients (behind
cardiovascular disease), with estimates showing that the post-transplant
rates of some cancers are 20 times higher than those seen in the general
population.”
He added that the use of mTOR inhibitors meant that limiting cancer development
was becoming more feasible. |
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