Abstract: TH-PO0183
Mini-Steroid Pulse Strategy to Enable Safe Use of Immune Checkpoint Inhibitors in Kidney Transplant Recipients with Solid Tumors
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Brito, Germana Alves, A C Camargo Cancer Center, São Paulo, SP, Brazil
- Murakami, Naoka, Washington University in St Louis, St. Louis, Missouri, United States
- Costa e Silva, Veronica Torres, Universidade de Sao Paulo, São Paulo, SP, Brazil
- Tavares, Monique Celestes, A C Camargo Cancer Center, São Paulo, SP, Brazil
- Pereira, Benedito J., A C Camargo Cancer Center, São Paulo, SP, Brazil
- De Barros e Silva, Milton José, A C Camargo Cancer Center, São Paulo, SP, Brazil
Background
Defining safe and effective immunosuppressive strategies in Kidney transplant recipients (KTRs) treated with Immune checkpoint inhibitors (ICIs) remains a clinical challenge.
Methods
We conducted a retrospective case series at a comprehensive cancer center in Brazil, analyzing KTRs with solid tumors treated with ICI for at least two cycles from June 2019 to April 2025. Two strategies were implemented to mitigate rejection risk: (1) Mini-steroid pulse every ICI cycle (prednisone 40 mg on days –1 to 3, 20 mg on days 4–6, and 10 mg on days 7–20), and (2) cross-taper to a mammalian target of rapamycin (mTOR) inhibitors (target trough level: 4–6 ng/mL), unless contra-indicated or in the case of patient’s refusal. Assessed outcomes were rate of kidney rejection, tumor response, and cumulative survival.
Results
Seven male patients were included (Table). A total of 42.9% of patients had creatinine-based estimated glomerular filtration rate (eGFRcr) < 30 mL/min/1.73 m2. The median number of cycles was 3 (range: 2–16). All patients received mini-steroid pulse; three patients were converted to mTOR inhibitors while four maintained prior immunosuppression. Median follow-up was 8.6 months (range 1.0–20.6 months). No acute rejection occurred. Tumor response was complete or partial in 4 (57.2%). Treatment-related grade ≥3 adverse events occurred in one patient who developed a severe infection. Mini-steroid pulse was discontinued, and ICI was resumed following clinical stabilization. A total of 57.2% were alive at last follow-up.
Conclusion
Mini-steroid pulse with or without mTOR inhibition, enabled safe ICI use in KTRs, including those with reduced eGFRcr, with no rejection and promising antitumor responses.
Table. Patient characteristics
Funding
- Private Foundation Support