| Strategy |
---|---|
Pre-treatment | Careful pre-treatment evaluation of patients for presence of immunodeficiency (e.g. HIV), past or family history of malignancy and pre-malignant conditions (e.g. Bowen's disease, CIN of cervix, GIT polyps, leukoplakia of lip) |
Dosages and therapy | Minimise dose and duration of immunosuppressive therapy (e.g. use of alkylating agents, such as cyclophosphamide for <12 months) - consider drugs with less oncogenic potential (e.g. MTX, mTOR inhibitors (sirolimus)) |
Education | Patient education - stop smoking, avoid excessive exposure to UV radiation, immunisation against HPV, regular self-examination (e.g. skin, lips, breast) |
Follow-up | Regular and annual review - screening for common immunosuppressive therapy associated malignancies (e.g. skin, cervix, bladder, lymph nodes) |