Metastatic cancer has been a feared disease due to the short survival after diagnosis and the lack of effective therapy. Surgery, Radiation therapy and Cytotoxic Chemotherapy had been the milestones of treatment developed up to the end of the 19th century. Unfortunately, with a few exceptional types like Germ Cell Tumors, most metastatic cancer patients will not outlive their disease. As we entered the 20 th century, we have made many important discoveries like cancer causing genes and we developed specific targeted inhibitors to correct these biological aberrations. The successful development of Immune Checkpoint inhibitors (ICI) in 2009 had been the start of a revolution for metastatic cancer treatment. Over the past decade, many different types of metastatic cancers were successfully treated and patients achieved long term durable remissions from their deadly diagnosis. Initially these were achieved with ICI alone, more recently, therapy evolved to ICI combinations, ICI combined with targeted therapy and ICI combined with chemotherapy. The current state of the art for ICI based therapy for metastatic cancers will be reviewed.
Patients who have received a transplanted organ are particularly prone to develop cancers due to the use of immune-suppressive therapy to prevent graft rejection. Are they candidates for ICI based therapy? The current limitations for using ICI in transplant related malignancy will be discussed and early successful adaption of ICI will be presented.
