In NEJM this week, a team of European researchers report on the use of sirolimus to prevent secondary skin cancers in patients who have undergone kidney transplants. Transplant recipients who develop cutaneous squamous-cell carcinomas are at a high risk for developing subsequent skin cancers, the team says. For this study, the researchers randomly assigned transplant recipients taking calcineurin inhibitors and had at least one cutaneous squamous-cell carcinoma to receive either sirolimus as a substitute for calcineurin inhibitors or to maintain their initial treatment. They found that patients in the sirolimus group had a significantly longer survival free of cutaneous squamous-cell carcinoma than patients in the calcineurin-inhibitor group, and fewer patients in the sirolimus group developed new squamous-cell carcinomas.
In JAMA this week, a team of US researchers reports on the risk of cervical pre-cancer and cancer in HIV-infected women who have no sign of an oncogenic HPV infection. The team studied 420 HIV-positive women and 279 HIV-negative women — 88 percent of the HIV-positive women and 91 percent of the HIV-negative women were HPV-negative with normal cervical cytology at enrollment. "Among these oncogenic HPV-negative women, 2 cases of [high-grade squamous intraepithelial lesions or greater] were observed; an HIV-uninfected woman and an HIV-infected woman with a CD4 cell count of 500 cells/μL or greater," the team says. "There were 6 cases of [cervical intraepithelial neoplasia 2 or greater] in 145 HIV-uninfected women and 9 cases in 219 HIV-infected women." Five years of accumulated data suggests that incidence of cervical cancer and pre-cancer was similar in HPV-negative women, regardless of HIV status, the team adds.
And in the British Medical Journal this week, researchers in Australia and South Africa evaluate the use of fecal immunochemical testing for human hemoglobin, followed by colonoscopy to screen for colorectal cancer and advanced colorectal neoplasia in kidney transplant recipients. The team enrolled 229 kidney transplant recipients aged 50 or older at least six months post-transplant and tested them using fecal immunochemical assays and colonoscopy. The researchers found advanced colorectal neoplasia in 29 of the participants — and fecal testing for hemoglobin was positive in 28 of the patients. "Sensitivity, specificity, and positive and negative predictive values for advanced neoplasia were 31.0%, 90.5%, 32.1%, and 90.1%," the authors write. "Fecal hemoglobin screening for colorectal neoplasia has similar performance characteristics in transplant recipients to those reported in general population studies, with poor sensitivity but reasonable specificity. Surveillance colonoscopy might be a more appropriate approach in this population."