利莫gene Laherparepvec治疗肾移植患者皮肤鳞状细胞癌。

IF 0.9 Q4 DERMATOLOGY
Max Miller, Nancy H Kim, Maya K Thosani, Justin C Moser
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引用次数: 0

摘要

一位66岁女性,因复发性血栓性血小板减少性紫癜而进行过两次肾移植,并伴有多处非转移性皮肤鳞状细胞癌(CSCC)。该患者先前接受了多次Mohs手术和放射治疗,但持续发生CSCC病变的频率越来越高。在讨论了多种治疗方案后,考虑到T-VEC可引起全身免疫反应,移植排斥的理论风险较低,最终选择了T-VEC治疗。在开始瘤内注射T-VEC后,治疗后的病变开始缩小,并且观察到新的CSCC病变发生率降低。由于不相关的肾脏并发症,在此期间出现了新的CSCCs。患者重新开始T-VEC治疗,无复发性肾脏问题。在重新开始治疗后,注射和非注射病变的大小都缩小了,新病变的发展再次停止。一个注射性病灶由于其大小和不适,通过Mohs显微摄影手术切除。在切片上,显示了旺盛的淋巴细胞浸润血管周围,这与T-VEC治疗反应一致,几乎没有活动性肿瘤。肾移植患者的非黑色素瘤皮肤癌发病率很高,他们的移植状况显著限制了治疗选择,特别是抗pd -1治疗。该病例提示,在免疫抑制的情况下,T-VEC可以产生局部和全身免疫反应,并且T-VEC可能是移植CSCC患者的有益治疗选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Use of Talimogene Laherparepvec to Treat Cutaneous Squamous Cell Carcinoma in a Renal Transplant Patient.

Use of Talimogene Laherparepvec to Treat Cutaneous Squamous Cell Carcinoma in a Renal Transplant Patient.

Use of Talimogene Laherparepvec to Treat Cutaneous Squamous Cell Carcinoma in a Renal Transplant Patient.

Use of Talimogene Laherparepvec to Treat Cutaneous Squamous Cell Carcinoma in a Renal Transplant Patient.

A 66-year-old female with a history of two renal transplants due to recurrent thrombotic thrombocytopenic purpura presented to clinic with multiple lesions identified to be non-metastatic cutaneous squamous cell carcinoma (CSCC). The patient previously underwent multiple Mohs procedures and radiation therapy treatment but continued to develop CSCC lesions with increasing frequency. After discussing multiple treatment options, it was elected to pursue treatment with Talimogene laherparepvec (T-VEC) given the systemic immune responses it can cause, with low theoretical risk of graft rejection. After starting intratumoral T-VEC injections, treated lesions began to decrease in size, and a reduction in the rate of new CSCC lesions was observed. Treatment was held due to unrelated renal complications during which time new CSCCs developed. Patient was restarted on T-VEC therapy with no recurrent renal issues. Upon reinitiating treatment, injected and non-injected lesions showed reduction in size, and the development of new lesions again ceased. One injected lesion was resected via Mohs micrographic surgery due to its size and discomfort. On sectioning, this demonstrated an exuberant lymphocytic perivascular infiltrate which was consistent with treatment response to T-VEC, with little active tumor. With high rates of non-melanoma skin cancer in renal transplant patients, their transplant status significantly limits treatment options, specifically with regards to anti-PD-1 therapy. This case suggests T-VEC can generate local and systemic immune responses in the setting of immunosuppression and that T-VEC may be a beneficial therapeutic option for transplant patients with CSCC.

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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
57
审稿时长
9 weeks
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