What is your strategy for managing immunosuppression in patients with a kidney transplant who develop metastatic cancer?

This is a difficult situation. I presume this question refers to cancers for which there is no option of cure. We always discuss the goals of care and review with the patient and their treating oncologist what the prognosis might be.

If chemotherapy or check-point inhibitor treatment is planned we ...

Modification of the immunosuppressive regimen may restore anti-neoplastic immune response and may help improve oncologic prognosis in cancer patients. Due to the lack of definitive data both physicians and patients are usually reluctant to modify immunosuppression, fearing rejection and potential gr...

Completely agree with Dr. @Dr. First Last on this, the only thing I would add is that tumor biology might differ between different malignancies. Certain cancers are more prone to effects of immunosuppression (non-melanomatous skin CA, renal cell CA, virus-driven malignancies like EBV assoc PTLD, HPV...