Administration of anti-neoplastic agents to treat malignancies in solid organ transplant recipients

Abstract

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. Simultaneous administration of chemotherapy and immunosuppressive agents may increase treatment toxicities. The data of SOT recipients treated at Roswell Park Cancer Institute (RPCI) was reviewed for different malignancies to assess their treatment patterns, tolerance and outcomes. Chart review of 40 SOT patients seen at RPCI (2000–2012) for cancer management was conducted. The median age was 61.5 years and 50% were males. The median lag time between SOT and cancer diagnosis was 8.4 years. It was found that 46% of solid tumors were metastatic at diagnosis, 78% received chemotherapy and 22% had hormonal therapy alone. In the chemotherapy group, the patients received an average of 1.8 lines of therapy, where 13% were given definitive chemotherapy and radiotherapy while 26% received chemotherapy in the neoadjuvant/adjuvant setting. Treatment delays were necessary in 32%, and dose omission or reduction in 42%. The most common hematologic adverse events (AEs) were anemia (78%) and thrombocytopenia (59%). Febrile neutropenia occurred in 12.5%. The most common non-hematologic AEs were fatigue (55%) and hepatic dysfunction (45%). The most common grade 3/4 hematologic AEs were neutropenia (33%) and leukopenia (27%) while non-hematologic grade 3/4 AEs was fatigue (12.5%). At the time of analysis, 26% patients were still alive. The median overall survival period of the patients was 28.5 months. In conclusion, SOT patients can tolerate chemotherapy; however AEs, dose reductions and delays occur. Thus, the treating physicians should be cautious on dosing chemotherapy in these cases.