Highlights: Hope for cancer-afflicted organ transplant patients

Promising results seen in administration of chemotherapy and hormonal therapy in solid organ transplant recipients

Source: National Cancer Institute


Source: National Cancer Institute


Can cancer patients with recent organ transplants, whose immune system is repressed in order to avoid organ rejection, withstand chemotherapy treatment which weaken cells further?

“The management of advanced malignancies in solid organ transplant (SOT) recipients is not well-structured as the patients need immunosuppressive agents to avoid graft rejection,” noted a team of researchers from Buffalo, NY, USA, in a medical paper published in the December 2015 issue of Advances in Modern Oncology Research journal.

“Simultaneous administration of chemotherapy and immunosuppressive agents may increase treatment toxicities,” they stated.

 A2The increased risk of primary malignancies in patients post-SOT on chronic immunosuppression has been well-documented since 1988, the researchers explained. The most common cancers developed in these cases are skin cancer, head and neck cancer, Kaposi sarcoma, gynecologic malignancies and lymphoproliferative disorders.

More than 110,000 patients receive solid organ transplants internationally every year, according to United Nation’s Global Observatory on Donation and Transplantation, and the number is increasing. While SOT patients continued to have improved survival with advancement of medical care and immunosuppression, they do have increased risk of developing malignancies compared to the general population.

This risk could be related to immunosuppression, viral infections or donor-transmitted cancers. Treatment of these malignancies may require “administration of chemotherapy or other anti-neoplastic agents that could lead to toxicities such as profound bone marrow suppression or end organ damage,” the researchers reported.

 As experience in this field is limited and only a few published data are available, according to the researchers, they studied the experience of an institute in treating various malignancies that developed in patients with history of SOT. The team, led by medical oncologist Dr Omar A Ustwani, examined patients at Roswell Park Cancer Institute in Buffalo and reviewed the data of SOT recipients to assess their treatment pattern, tolerance and outcomes.

The researchers pointed out that treatments of post-SOT malignancies may require chemotherapy, hormonal therapy or biologic agents similar to cancer patients without the history of SOT. Cancer can develop as early as 22 months into post-SOT but may also take up to 10 years to be detected. “The mean number of years between date of transplantation and developing cancer was 8.4 years in our study, which is consistent with the published data,” mentioned their report.

The researchers further explained that immunosuppression inhibits host defense and surveillance, which could play a role in allowing growth of microscopic malignant cells. In addition, some immunosuppressive agents such as azathioprine and cyclosporine have been suggested to promote carcinogenesis.

While the current literature on post-SOT malignancies mainly focuses on renal transplant patients, their study reviewed a collection of various transplantations including renal, liver and a few lung and heart transplant patients.

“Our study did not show a difference in overall survival (OS) between renal and non-renal transplant patients with a median survival of 24.2 months among all the patients. A previous study that assessed lung cancer alone in a group of various organ transplantation patients (N= 24) reported a median OS of 1.5 years. Although the number of lung cancer patients (N=6) in our study is small, the median OS is slightly better (2.1 years) with similar stage distribution (about a third of patients diagnosed with stage IV at diagnosis),” the study noted.

Despite limitations of their data, the researchers reported that chemotherapy is tolerable to cancer-afflicted SOT patients, but precaution to adverse events (AEs) is advised. “No effect was noted on OS with additive multiple immunosuppressive agents in our patients. Dose reduction of immunosuppressive agents is common when cancer is diagnosed, but it needs to be balanced with the preservation of graft function,” the researchers stated.

“SOT patients can tolerate chemotherapy; however AEs such as dose reductions and delays occur. Thus, the treating physicians should be cautious on dosing chemotherapy in these cases,” they concluded.

Prospective studies are warranted to confirm these findings, the impact and adjustment of immunosuppressive agents during the systemic treatment for post-SOT malignancies, the researchers advised, but the study does offer insight into patterns and safety of cancer-directed treatments in a subset of patients with delicate organ function.

“Although it is a retrospective study accounting for a small number of patients, the study shows promising results of feasible yet cautious administration of chemotherapy and hormonal therapy in SOT recipients with relatively good tolerance,” according to the researchers.

Read more on the study here.