Keywords
Tacrolimus. Everolimus. Intraepithelial cervical neoplasia. Human papilloma virus.
How to Cite
1.
Lafuente Covarrubias O, Sánchez Sobrino B, Zalamea Jarin F, Portolés Pérez J. Conversion of calcineurin inhibitors by mTOR inhibitors contributes to the treatment of intraepithelial neoplasms in the cervix in women with renal transplantation. Rev. Colomb. Nefrol. [Internet]. 2014 Jul. 1 [cited 2024 Apr. 19];1(2):130-3. Available from: https://revistanefrologia.org/index.php/rcn/article/view/184
Abstract
The patient is a 32-year-old woman with a history of chronic kidney disease due to interstitial nephritis. After 2 years on hemodialysis the patient received a renal transplant and was treated with standard immunosuppression: steroids, mycophenolate mofetil and tacrolimus. Three years later the patient presented a squamous intraepithelial neoplasia in the cervix and infection with human papilloma virus (HPV), with poor response to local treatment with cryotherapy and laser. Because calcineurin inhibitors have a higher risk of presenting cancer such as non-Hodgkin’s lymphoma and skin cancer, and because inhibitors of the mammalian target of rapamycin (mTOR) at the intracellular level could reverse premalignant skin tumor lesions in the head and neck, tacrolimus, was suspended and changed to everolimus, an mTOR inhibitor. As a result, both cervical lesion and HPV infection disappeared 6 years later, with a fair renal function and no episodes of renal graft rejection.References
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8. Feng W, Duan X, Liu J, Xiao J, Brown RE. Morphoproteomic evidence of constitutively activated and overexpressed mTOR pathway in cervical squamous carcinoma and high grade squamous intraepithelial lesions. Int J Clin Exp Pathol. 2009;2(3):249-60.
9. Molinolo AA, Marsh C, El Dinali M, Gangane N, Jennison K, Hewitt S, et al. mTOR as a molecular target in HPV-associated oral and cervical squamous carcinomas. Clin Cancer Res. 012;18(9):2558-68.
10. Berkowitz RP. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;122(2 Pt 1):393.
2. Palefsky JM, Cranston RD. Virology of human papillomavirus infections and the link to cancer 2012 [cited 2013]. Available from: http://www.uptodate.com.
3. Paternoster DM, Cester M, Resente C, Pascoli I, Nanhorngue K, Marchini F, et al. Human papilloma virus infection and cervical intraepithelial neoplasia in transplanted patients. Transplant Proc. 2008;40(6):1877-80.
4. Pietrzak B, Bobrowska K, Szpotanska-Sikorska M, Jabiry-Zieniewicz Z, Kociszewska-Najman B, Durlik M, et al. Multiple types of high-risk human papilloma virus in the lower genital tract of a female kidney recipient: a case report. Transplant Proc. 2011;43(8):2994-6.
5. Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121(4):829-46..
6. Connolly K, Manders P, Earls P, Epstein RJ. Papillomavirus-associated squamous skin cancers following transplant immunosuppression: one Notch closer to control. Cancer Treat Rev. 2014;40(2):205-14.
7. Wu J, Chen J, Zhang L, Masci PP, Zhao KN. Four Major Factors Regulate Phosphatidylinositol 3-kinase Signaling Pathway in Cancers Induced by Infection of Human Papillomaviruses. Curr Med Chem. 2014;21(26):3057-69.
8. Feng W, Duan X, Liu J, Xiao J, Brown RE. Morphoproteomic evidence of constitutively activated and overexpressed mTOR pathway in cervical squamous carcinoma and high grade squamous intraepithelial lesions. Int J Clin Exp Pathol. 2009;2(3):249-60.
9. Molinolo AA, Marsh C, El Dinali M, Gangane N, Jennison K, Hewitt S, et al. mTOR as a molecular target in HPV-associated oral and cervical squamous carcinomas. Clin Cancer Res. 012;18(9):2558-68.
10. Berkowitz RP. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;122(2 Pt 1):393.
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