Immunosuppressive Medications and Squamous Cell Skin Carcinoma

It has been noted in that past that people who take immunosuppressive medication have been much more likely to be diagnosed with squamous cell skin carcinoma (SCSC), a specific skin cancer that is especially prominent in this population. The authors of this paper wanted to explore the difference in patients who took cyclosporine and azathioprine, an immunosuppressant that is also a known to allow skin cells to rapidly divide after UV exposure, and those who took mycophenolic acid, a newer immunosuppressant, and tacrolimus. These two regimens represent an older and a newer regimen, respectively, for those who have an organ transplant. This research team’s goal was to find out if the newer medication regimen allowed for a lower risk of SCSC. The study ultimately included patients who had received certain organs during a specific time frame, and then each confirmed SCSC case was matched with two similar patient cases to be the controls  based on a list of criteria. After being selected and grouped based on a simple interview that was mailed out, the participants completed an in-person interview that focused on their demographics, social history, family history, and their use of immunosuppressive drugs.

The two main objectives of the study were to determine if the mycophenolate medications had the same risk to cause skin cancer as azathioprine and to determine if the choice of calcineurin inhibitor impacted the risk for SCSC which would be cyclosporine versus tacrolimus. The final conclusion was that azathioprine’s association with an increased risk of SCSC was confirmed, but a new finding was that including mycophenolate whether with or instead of azathioprine showed a lower risk of SCSC. It was also determined that there was no significant difference between the calcineurin inhibitors in terms of SCSC risk. More research will be needed to determine if mycophenolate is actually protective against SCSC or if it just allows for less risk of this because there were not many patients who were on both azathioprine and mycophenolate.

Coghill AE, Johnson LG, Berg D, et al. Immunosuppressive medications and squamous cell skin carcinoma: nested case-control study within the skin cancer after organ transplant (SCOT) cohort. Am J Transplant. 2016;16:565-73.

Cancer prevention is something that is very important to me. I think that it is wonderful that these researchers are taking steps to look into ways to keep transplant patients health after their transplants. Could these types of issues be solved with other immunosuppressive agents that are on the market today? Are there ways to at least minimize the problems that come along with these types of drugs?