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Title: | The risk of cancer in kidney transplant recipients may be reduced in those maintained on everolimus and reduced cyclosporine. | Authors: | Kanellis J.;Chadban S.J.;Lim W.H.;Russ G.R.;Wong G.;Pilmore H. | Institution: | (Lim) Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia (Lim) University of Western Australia, Perth, Australia (Russ) Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia (Wong) Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia (Wong) Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia (Pilmore) Renal Unit, Auckland Hospital, Auckland, New Zealand (Pilmore) Department of Medicine, Auckland University, Auckland, New Zealand (Kanellis) Department of Nephrology and Transplant Services, Monash Medical Centre, Melbourne, Australia (Chadban) Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia (Chadban) Kidney Node, Charles Perkins Centre, University of Sydney, Australia | Issue Date: | 8-Apr-2017 | Copyright year: | 2017 | Publisher: | Elsevier B.V. | Place of publication: | Netherlands | Publication information: | Kidney International. 91 (4) (pp 954-963), 2017. Date of Publication: 01 Apr 2017. | Journal: | Kidney International | Abstract: | Kidney transplant recipients are at a high risk of developing cancers after transplantation. Switching from calcineurin inhibitors to sirolimus has been shown to prevent secondary nonmelanoma skin cancer but whether everolimus with reduced exposure to calcineurin inhibitors has similar anti-cancer effects remains unknown. Therefore, we compared the risk of incident cancer over seven years of follow-up among kidney transplant recipients randomized to everolimus plus reduced exposure cyclosporine versus mycophenolate sodium and standard exposure cyclosporine. Using the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), we assessed the seven-year risk of incident cancer and other graft outcomes among a subgroup of recipients who had participated in the A2309 study using adjusted Cox proportional hazard models. Of 95 recipients, 66 were randomized to everolimus (1.5 mg or 3 mg) with reduced cyclosporine and 29 received mycophenolate sodium and standard exposure cyclosporine. Compared to mycophenolate sodium and standard exposure cyclosporine, everolimus treatment was associated with unadjusted hazard ratios of 0.28 (95% confidence interval 0.11-0.74), 0.39 (0.16-0.98) and 0.41 (0.23-0.71), respectively for nonmelanoma skin cancer, non-skin cancers and any cancers. Interestingly, the adjusted hazard ratios were 0.34 (0.13-0.91), 0.35 (0.09-1.25) and 0.32 (0.15-0.71), respectively. There was no association between treatment groups and rejection, graft loss or death. Compared to standard-exposure cyclosporine, everolimus with reduced exposure to cyclosporine may be associated with a reduced risk of cancer, particularly for non-melanoma skin cancer. Thus, if confirmed in larger patient cohorts, de novo use of everolimus with reduced exposure to calcineurin inhibitors may enable a reduction in cancer burden after transplantation.Copyright © 2017 International Society of Nephrology | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.kint.2016.11.008 | Link to associated publication: | Click here for full text options | PubMed URL: | 28109543 [http://www.ncbi.nlm.nih.gov/pubmed/?term=28109543] | ISSN: | 0085-2538 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/38821 | Type: | Article | Subjects: | article bk virus infection/si [Side Effect] cancer chemotherapy cancer risk clinical effectiveness controlled study cytomegalovirus infection/si [Side Effect] drug efficacy drug exposure drug withdrawal edema/si [Side Effect] female follow up graft recipient human hyperlipidemia/si [Side Effect] kidney graft kidney graft rejection/co [Complication] kidney graft rejection/dt [Drug Therapy] kidney graft rejection/pc [Prevention] major clinical study male *malignant neoplasm/dt [Drug Therapy] malignant neoplasm/dt [Drug Therapy] non melanoma skin cancer/dt [Drug Therapy] outcome assessment randomized controlled trial risk assessment viremia/si [Side Effect] wound complication/si [Side Effect] *cyclosporin/ct [Clinical Trial] *cyclosporin/dt [Drug Therapy] *everolimus/ae [Adverse Drug Reaction] *everolimus/dt [Drug Therapy] mycophenolic acid/ae [Adverse Drug Reaction] mycophenolic acid/ct [Clinical Trial] mycophenolic acid/dt [Drug Therapy] *everolimus/ct [Clinical Trial] adult drug withdrawal edema / side effect female follow up graft recipient human hyperlipidemia / side effect kidney graft kidney graft rejection / complication / drug therapy / prevention major clinical study male *malignant neoplasm / *drug therapy malignant neoplasm / drug therapy non melanoma skin cancer / drug therapy outcome assessment randomized controlled trial risk assessment wound complication / side effect viremia / side effect adult cancer chemotherapy cancer risk clinical effectiveness controlled study cytomegalovirus infection / side effect drug efficacy drug exposure Article bk virus infection / side effect |
Type of Clinical Study or Trial: | Randomised controlled trial |
Appears in Collections: | Articles |
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