A trial was presented about looking at Sirolimus(SRL) in primary prevention of skin cancer in kidney transplant recipients. Patients with history of known skin cancer who had received a kidney transplant were randomized to continue their current CNI based regimen or change to a SRL based regimen.
Use of SRL based regimen showed a 67% risk reduction of skin cancer. Data on post CrCl and proteinuria was not presented. It shows again and again to use that SRL is a very good cancer preventive agent but can it prevent acute rejection episodes and proteinuria is not clear. Data from Canada in mice studies discussed earlier in the Onco Nephrology pre course by Dr. Susan Quaggin shed light on the mTOR pathway. It appears that if the mTOR pathway is completely knocked out in mice, they developed collapsing FSGS and ESRD in 3-4 weeks. Clinically, perhaps SRL doesn't do a complete blockade and hence we don't get such drastic findings but here and there we do hear about the significant proteinuria from SRL.
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