Background: Nonmelanoma skin cancer is the most prevalent post-transplant malignancy found in renal transplant recipients. Long term immunosuppressant therapy, previous history of nonmelanoma skin cancer and UV exposure are the greatest drivers of these malignancies in renal transplant recipients compared to the general population. Squamous cell carcinoma is the most prevalent type of nonmelanoma skin cancer lesions that can lead to increased morbidity and metastasis in this population. Sirolimus is a relatively new immunosuppressant that is known to have anti-tumor effects, especially in the instance of skin cancer. Will sirolimus reduce the recurrence of nonmelanoma skin cancer in renal transplant recipients with a previous history of nomelanoma skin cancer?
Method: An extensive medical literature search was completed using MEDLINE, CINAHL, EBSCO, and Web of Knowledge. Search terms used included skin cancer, skin neoplasm, organ transplant, renal transplant, and sirolimus. Relevant articles were further evaluated for quality using the GRADE criteria.
Results: Three randomized controlled trials met the inclusion criteria of the systematic review. The studies showed a decreased incidence of nonmelanoma skin cancer in renal transplant recipients with a history of nonmelanoma skin cancer. One study demonstrated a significantly longer survival free of squamous cell carcinoma in the sirolimus group compared to calcineurin inhibitor therapy. Another study found a significantly decreased rate of nonmelanoma skin cancer in the sirolimus group. All studies observed an increased incidence of adverse drug reactions in the sirolimus group that led to high discontinuation rates. The overall quality of evidence was low after assessing each study with GRADE criteria.
Conclusion: The findings suggest that sirolimus is effective at reducing the recurrence of nonmelanoma skin cancer lesions in renal transplant recipients with a history of nonmelanoma skin cancer. While there appears to be some significance for sirolimus conversion of renal transplant recipients with nonmelanoma skin cancer, better quality research is necessary to determine the long term effects of sirolimus in renal transplant patients. Further studies are needed to determine when sirolimus should be initiated in patients to prevent skin cancer and treatment duration.
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