Cutaneous squamous cell carcinoma in solid organ transplant recipients: Current therapeutic and screening strategies
Ann‐Kristin Struckmeier, Martin Gosau, Ralf Smeets
Abstract
Solid organ transplant recipients (SOTRs) are particularly prone to developing malignancies, often manifesting multiple tumors and tumors with a heightened susceptibility to metastasis, resulting in much lower survival rates when compared to the general population. Among these, cutaneous squamous cell carcinoma (CSCC) respresent a major challenge in terms of morbidity and mortality following organ transplantation. The management of post-transplant CSCC requires expertise from various disciplines, including dermatology, maxillofacial surgery, transplant medicine, radiation oncology, and medical oncology. Furthermore, the unique behaviors and prevalence of tumors in SOTRs necessitate tailored pathways for screening and treatment, distinct from those designed for immunocompetent patients. Despite the proven efficacy of immune checkpoint inhibitors (ICIs) in several cancers, SOTRs have often been systematically excluded from clinical trials due to concerns about potential allograft rejection and loss. Consequently, most data on the safety and efficacy of ICIs in SOTRs are derived from case series and reports. Given the significant risks involved, alternative therapeutic options should be thoroughly discussed with patients before considering ICI therapy. This literature review aims to provide an overview of CSCC in SOTRs, with a specific emphasis on therapeutic and screening strategies, particularly highlighting immunotherapy. • SOTRs have a higher risk of CSCC, with tumors being more frequent and posing greater risks of recurrence and metastasis. • Due to the unique traits and higher CSCC incidence in SOTRs, specialized screening and treatment are crucial. • Further research and clinical trials are essential to validate the efficacy of immune checkpoint inhibitors in SOTRs. • Understanding the tumor microenvironment and finding the optimal immunosuppressive regimen for SOTRs is essential. • Discussions with patients about allograft rejection risks and alternatives are essential before ICI therapy.