*Purpose: Over half of solid organ transplant recipients (SOTR) develop nonmelanoma skin cancers (NMSC) and up to 80% experience recurrence. Many immunosuppressive drugs are known to have direct oncogenic effects. Current guidelines recommend mTOR inhibitors in patients with NMSC due to their antineoplastic properties. Studies have shown that transitioning SOTR from a CNI to sirolimus reduces recurrence of NMSC. However, this benefit has not been formally associated with everolimus (EVR). This study aims to evaluate the impact of everolimus (EVR) on recurrence of nonmelanoma skin cancer (NMSC) in solid organ transplant recipients (SOTR).

*Methods: This was a retrospective cohort study performed at an academic medical center. Included patients were adult SOTR with a history of posttransplant NMSC. Patients were excluded if they had a history of any cancer pretransplant, nonskin cancer or melanoma skin cancer posttransplant, or if the immunosuppressive regimen contained sirolimus or belatacept. Recurrence of NMSC within 3 years of initial diagnosis was compared between patients who received EVR following diagnosis (n=11) and a control group of patients who were kept on regimens not containing an mTOR inhibitor (n=28). Secondary outcomes included impact of EVR on time to recurrence of NMSC and EVR discontinuations due to adverse effects.

*Results: Baseline patient characteristics were similar between groups. Eight patients (72%) in the EVR group and 18 patients (64%) in the control group experienced recurrence of NMSC within 3 years (p=0.72). Eight patients (72%) in the EVR group had no recurrence after initiation of EVR (p=0.13). Refer to Table 1. The median time from NMSC diagnosis to EVR initiation was 393 days. The median time to first recurrence was 299 days in the EVR group and 432 days in the control group. Four patients discontinued EVR due to adverse effects (p=0.16).

*Conclusions: Transitioning to an EVR containing regimen was not associated with a reduction in recurrence of NMSC in this cohort. A limitation of this observation is that the median time to EVR initiation after NMSC diagnosis was greater than the median time to first recurrence. While not statistically significant, 2 patients experienced potential serious adverse effects and 2 patients experienced minor adverse effects of EVR necessitating discontinuation. Limitations of this study include the observational study design and the small number of patients switched to EVR.

« Back to 2019 American Transplant Congress