A case of esophageal adenocarcinoma on long-term rapamycin monotherapy

Transpl Int. 2015 Oct;28(10):1240-4. doi: 10.1111/tri.12600. Epub 2015 May 19.

Abstract

Cancer in transplant recipients represents a therapeutic challenge even when the patient is already under mTOR inhibitors. A 78-year-old man received a deceased donor kidney transplant in 1993. After 6 months, he developed a multifocal cutaneous and nonvisceral Kaposi's Sarcoma while on cyclosporine immunosuppressant therapy. The patient was converted to sirolimus monotherapy in 2001 with subsequent complete recovery within 2 years. In 2007, the patient was diagnosed with an esophageal adenocarcinoma stage IIA. An esophagectomy was performed without requirement of further treatment. He has continued on sirolimus monotherapy ever since, with no other incidents and no recurrences of either tumor. In this report, we describe an interesting case of a second cancer while on immunosuppressive therapy with anticancer activity. Moreover, the present knowledge of the matter is discussed.

Keywords: TOR-inhibitors; immunosuppression; immunosuppression clinical; kidney clinical; malignancies and long term compliations; molecular diagnostic; solid tumors.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma* / surgery
  • Aged
  • Azathioprine / therapeutic use
  • Biomarkers
  • Cyclosporine / adverse effects
  • Cyclosporine / therapeutic use
  • Drug Substitution
  • Esophageal Neoplasms* / surgery
  • Esophagectomy
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation*
  • Male
  • Neoplasm Proteins / metabolism
  • Neoplasms, Second Primary* / surgery
  • Phosphorylation
  • Postoperative Complications* / etiology
  • Postoperative Complications* / surgery
  • Prednisone / adverse effects
  • Prednisone / therapeutic use
  • Protein Processing, Post-Translational
  • Sarcoma, Kaposi / etiology
  • Signal Transduction
  • Sirolimus / adverse effects
  • Sirolimus / therapeutic use*
  • Skin Neoplasms / etiology
  • TOR Serine-Threonine Kinases / antagonists & inhibitors
  • TOR Serine-Threonine Kinases / metabolism

Substances

  • Biomarkers
  • Immunosuppressive Agents
  • Neoplasm Proteins
  • Cyclosporine
  • MTOR protein, human
  • TOR Serine-Threonine Kinases
  • Azathioprine
  • Prednisone
  • Sirolimus