Long-Term Efficacy and Allograft Loss after Immune Checkpoint Inhibitor Therapy in Solid Organ Transplant Recipients with Advanced Cutaneous Squamous Cell Carcinoma
- 1Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear | Mass General Brigham, Boston, Massachusetts, USA;Computational and Artificial Intelligenc
Abstract
BackgroundImmune checkpoint inhibitors (ICIs) can provide effective treatment for advanced cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs), but long-term oncologic and allograft outcomes remain poorly characterized.
ObjectiveTo evaluate long-term efficacy and allograft outcomes after ICI therapy in SOTRs with advanced CSCC.
MethodsWe conducted a retrospective cohort study of SOTRs with advanced CSCC treated with systemic ICI at Mass General Brigham from 2016-2025. Tumor response, survival, immune-related adverse events, immunosuppression modifications, rejection rate, and graft loss were assessed. Kidney graft failure was analyzed using competing-risk methods with death as a competing event.
ResultsAmong 36 SOTRs, objective response rate was 44.4% (95% CI, 27.9%-61.9%), including 9 complete responses. At 3 years, progression-free, disease-specific, and overall survival were 18.6%, 65.8%, and 32.5%, respectively. Median follow-up was 42.1 months. Five patients experienced graft loss, all kidney recipients; 4 had biopsy-confirmed rejection. The 3-year cumulative incidence of kidney graft failure was 16.7% (95% CI, 2.9%-30.5%).
LimitationsRetrospective design, modest sample size, and heterogeneous immunosuppression limited risk-factor analyses.
ConclusionICI provided long-term CSCC control with a low rate of allograft loss, highlighting the need for longitudinal multidisciplinary management balancing oncologic benefit, graft preservation, and competing mortality risk.
CapsuleO_LILong-term outcomes remain poorly defined despite responses to immune checkpoint inhibitors in solid organ transplant recipients with advanced cutaneous squamous cell carcinoma. C_LIO_LIA 44.4% objective response rate, 65.8% 3-year disease-specific survival, and 16.7% 3-year kidney graft failure incidence support shared decision-making and coordinated cancer and transplant monitoring. C_LI
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BibTeX
@misc{wu2026longterm,
title = {{Long-Term Efficacy and Allograft Loss after Immune Checkpoint Inhibitor Therapy in Solid Organ Transplant Recipients with Advanced Cutaneous Squamous Cell Carcinoma}},
author = {H. Wu and M. Murphy and C. Becot and A. M. Fragano and E. H. S. Lin and S. Surapaneni and D. Shirvani and C. Cimoch and R. Merkin and S. Cohen and W. W. Williams and K. Emerick and H. L. Kaufman and S. Z. Shalhout},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.17.26363341},
url = {https://www.medrxiv.org/content/10.64898/2026.09.17.26363341v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Long-Term Efficacy and Allograft Loss after Immune Checkpoint Inhibitor Therapy in Solid Organ Transplant Recipients with Advanced Cutaneous Squamous Cell Carcinoma
AU - H. Wu
AU - M. Murphy
AU - C. Becot
AU - A. M. Fragano
AU - E. H. S. Lin
AU - S. Surapaneni
AU - D. Shirvani
AU - C. Cimoch
AU - R. Merkin
AU - S. Cohen
AU - W. W. Williams
AU - K. Emerick
AU - H. L. Kaufman
AU - S. Z. Shalhout
PY - 2026
DA - 2026/09/17
PB - medRxiv
DO - 10.64898/2026.09.17.26363341
UR - https://www.medrxiv.org/content/10.64898/2026.09.17.26363341v1
AB - BackgroundImmune checkpoint inhibitors (ICIs) can provide effective treatment for advanced cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs), but long-term oncologic and allograft outcomes remain poorly characterized. ObjectiveTo evaluate long-term efficacy and allograft outcomes after ICI therapy in SOTRs with advanced CSCC. MethodsWe conducted a retrospective cohort study of SOTRs with advanced CSCC treated with systemic ICI at Mass General Brigham from 2016-2025. Tumor response, survival, immune-related adverse events, immunosuppression modifications, rejection rate, and graft loss were assessed. Kidney graft failure was analyzed using competing-risk methods with death as a competing event. ResultsAmong 36 SOTRs, objective response rate was 44.4% (95% CI, 27.9%-61.9%), including 9 complete responses. At 3 years, progression-free, disease-specific, and overall survival were 18.6%, 65.8%, and 32.5%, respectively. Median follow-up was 42.1 months. Five patients experienced graft loss, all kidney recipients; 4 had biopsy-confirmed rejection. The 3-year cumulative incidence of kidney graft failure was 16.7% (95% CI, 2.9%-30.5%). LimitationsRetrospective design, modest sample size, and heterogeneous immunosuppression limited risk-factor analyses. ConclusionICI provided long-term CSCC control with a low rate of allograft loss, highlighting the need for longitudinal multidisciplinary management balancing oncologic benefit, graft preservation, and competing mortality risk. CapsuleO_LILong-term outcomes remain poorly defined despite responses to immune checkpoint inhibitors in solid organ transplant recipients with advanced cutaneous squamous cell carcinoma. C_LIO_LIA 44.4% objective response rate, 65.8% 3-year disease-specific survival, and 16.7% 3-year kidney graft failure incidence support shared decision-making and coordinated cancer and transplant monitoring. C_LI
ER -