Immunotherapy in Liver Transplant Recipients with Advanced Solid Malignancies: A Three-Patient Case Series.
6 affiliations
- 1Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada.
- 2Département d'oncologie médicale, Institut Gustave Roussy, 94805 Villejuif, France.
- 3Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC J1H 5H3, Canada.
- 4Cedars Cancer Centre, McGill University Health Centre, Montreal, QC H4A 3J1, Canada.
- 5Department of Oncology, St. Mary's Hospital Center, Montreal, QC H3T 0A2, Canada.
- 6Division of Gastroenterology & Hepatology, McGill University, Montreal, QC H4A 3J1, Canada.
Abstract
The use of immune checkpoint inhibitors (ICIs) after liver transplantation (LT) remains controversial, because immune activation may cause allograft rejection. Evidence in non-hepatocellular carcinoma (HCC) malignancies is limited. We retrospectively reviewed three LT recipients treated with pembrolizumab for advanced non-HCC malignancies at the McGill University Health Centre; treatment began between May 2020 and January 2025, and follow-up was censored on 31 January 2026. A patient with PD-L1-negative non-small cell lung cancer (NSCLC) achieved stable disease for approximately seven months, whereas a patient with PD-L1-high NSCLC achieved a durable partial response with progression-free survival of approximately 36 months. A third patient with cutaneous squamous cell carcinoma achieved a near-complete radiologic and metabolic response after two cycles. Pembrolizumab was held after this response; subsequent liver-test abnormalities raised concern for graft injury, but biopsy showed no histologic rejection and supported treatment resumption. No clinical or biochemical evidence of rejection was observed in Cases 1 and 2. At cutoff, Case 3 was alive and receiving pembrolizumab after seven cycles. These cases support a cancer-specific, individualized risk-benefit assessment in which expected oncologic benefit, alternatives, graft history, immunosuppression, and acceptance of graft-loss risk guide multidisciplinary treatment and close graft surveillance.
Related
- Risk Factors and Outcomes of Vancomycin-Resistant Enterococcus faecium Bloodstream Infection in Hematologic Malignancies and Stem Cell Transplant Recipients: A Case-Control Study
- Long-Term Efficacy and Allograft Loss after Immune Checkpoint Inhibitor Therapy in Solid Organ Transplant Recipients with Advanced Cutaneous Squamous Cell Carcinoma
- Association of eplet mismatch load and allograft injury in kidney transplant recipients
- The Tell-Tale Heart ― Persistent Immune Activation in Histologically Rejection-Free Heart Transplant Recipients ―
- Retrospective evaluation of predictors and clinical impact of postoperative delirium in liver transplant recipients
BibTeX
@article{jiao2026immunotherapy,
title = {{Immunotherapy in Liver Transplant Recipients with Advanced Solid Malignancies: A Three-Patient Case Series.}},
author = {Belinda Jiao and Charles Vincent Rajadurai and Nissim Benizri and Arielle Sabbah and Scott Owen and Khashayar Esfahani and Marc Deschenes and Philip Wong and Xun Zhao and Jamil Asselah},
journal = {Current oncology (Toronto, Ont.)},
year = {2026},
month = oct,
doi = {10.3390/curroncol33100623},
url = {https://europepmc.org/article/MED/42930190},
note = {CC BY},
}
RIS
TY - JOUR
TI - Immunotherapy in Liver Transplant Recipients with Advanced Solid Malignancies: A Three-Patient Case Series.
AU - Belinda Jiao
AU - Charles Vincent Rajadurai
AU - Nissim Benizri
AU - Arielle Sabbah
AU - Scott Owen
AU - Khashayar Esfahani
AU - Marc Deschenes
AU - Philip Wong
AU - Xun Zhao
AU - Jamil Asselah
PY - 2026
DA - 2026/10/16
JO - Current oncology (Toronto, Ont.)
DO - 10.3390/curroncol33100623
UR - https://europepmc.org/article/MED/42930190
AB - The use of immune checkpoint inhibitors (ICIs) after liver transplantation (LT) remains controversial, because immune activation may cause allograft rejection. Evidence in non-hepatocellular carcinoma (HCC) malignancies is limited. We retrospectively reviewed three LT recipients treated with pembrolizumab for advanced non-HCC malignancies at the McGill University Health Centre; treatment began between May 2020 and January 2025, and follow-up was censored on 31 January 2026. A patient with PD-L1-negative non-small cell lung cancer (NSCLC) achieved stable disease for approximately seven months, whereas a patient with PD-L1-high NSCLC achieved a durable partial response with progression-free survival of approximately 36 months. A third patient with cutaneous squamous cell carcinoma achieved a near-complete radiologic and metabolic response after two cycles. Pembrolizumab was held after this response; subsequent liver-test abnormalities raised concern for graft injury, but biopsy showed no histologic rejection and supported treatment resumption. No clinical or biochemical evidence of rejection was observed in Cases 1 and 2. At cutoff, Case 3 was alive and receiving pembrolizumab after seven cycles. These cases support a cancer-specific, individualized risk-benefit assessment in which expected oncologic benefit, alternatives, graft history, immunosuppression, and acceptance of graft-loss risk guide multidisciplinary treatment and close graft surveillance.
SN - 1198-0052
SN - 1718-7729
ER -