Transplanted patients (tpts) display higher cancer incidence rates compared to general population. Anti-tumor treatment after transplantation remains scarcely described. This study aimed to report oncological therapy feasibility and outcome in tpts with de novo cancers.
We retrospectively analyzed all consecutive cases of de novo cancer in renal and liver tpts treated in our center. Pts were identified based on systematic research in tpts databases from 2000 to 2016. Pts presenting with non-melanic cutaneous tumors only were excluded. Clinical features, treatments, toxicity and survival data were collected. Active optimal treatment was assessed by comparing treatment that was actually administered with guidelines.
Among 4637 tpts, 209 cases of de novo cancer were identified in 176 (3.8%) pts. Mean age was 52.5+/-11.3 at transplantation and 59+/-10.6 at cancer diagnosis; 122 (69%) were men; 96 (55%) were renal tpts and 80 (45%) liver tpts. At cancer diagnosis, performance status (PS) was 0-1 in 89% (n = 142/160). Tumor type was mainly epithelial (75%, n = 150/200); tumor stage was localized in 80% (n = 163/205) and advanced in 20% (n = 42/205) . Among pts with initially localized tumors, 13% (n = 22/163) had cancer recurrence. Median overall survivals of pts with localized and advanced cancer were of 166 (CI95%: 100.3-ND) and 8.8 (CI95%: 5.0-47.2) months, respectively Among pts with localized tumors, 80% (n = 134/156) received optimal treatment. Reasons for non-optimal treatment were comorbidities in 36% (n = 8/22), risks for the transplant in 36% (n = 8/22), and/or toxicity in 36% (n = 8/22). In contrast, at advanced/recurrent stage, only 36% (n = 19/53) of pts received optimal treatment, and 28% (n = 15/53) best supportive care only. Barriers to optimal treatment were comorbidities in 19% (n = 6/32), risks for the transplant in 22% (n = 7/32), toxicities in 19% (n = 6/32), and poor PS in 33% (n = 17/32).
Oncological treatments are feasible in tpts and survival seems similar to general population. Concerns about the risk of toxicity for the transplanted organ and comorbidities were the main reasons for non-optimal treatment. These observations warrant confirmation in a prospective multicenter study.
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Legal entity responsible for the study
CHU Henri Mondor
All authors have declared no conflicts of interest.