Antineoplastic chemotherapy and immunosuppression in liver transplant recipients: Squaring the circle?
Male
Humans
Carcinoma, Hepatocellular
/ drug therapy
Retrospective Studies
Liver Transplantation
/ adverse effects
Liver Neoplasms
/ drug therapy
Immunosuppressive Agents
Antineoplastic Agents
Immunosuppression Therapy
/ adverse effects
Calcineurin Inhibitors
/ therapeutic use
Transplant Recipients
Graft Rejection
/ drug therapy
antineoplastic chemotherapy
cancer
immunosuppression
liver transplantation
survival
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
revised:
27
09
2022
received:
03
05
2022
accepted:
08
10
2022
pubmed:
18
11
2022
medline:
18
1
2023
entrez:
17
11
2022
Statut:
ppublish
Résumé
Malignancies are a major cause of late death after liver transplantation (LT). In LT recipients presenting a malignancy, antineoplastic chemotherapy is central part of the therapeutic arsenal, but management of both immunosuppressive and antineoplastic chemotherapy can be very challenging. The aim of the present retrospective study was to describe a recent single center cohort of LT recipients treated with antineoplastic cytotoxic chemotherapy. All LT recipients who received antineoplastic chemotherapy in our center between 2005 and 2021 were included. The study population included 72 antineoplastic chemotherapy courses in 69 patients. There was a majority of men (81.9%); median age at LT was 54.9 (range 1-68) and was 63.0 (18-79) at the diagnosis of malignancy. Lung carcinomas (23.6%), head and neck carcinomas (20.8%), lymphomas (16.7%), and recurrent hepatocellular carcinoma (HCC) (8.3%) were the most frequent malignancies. Neoadjuvant (30.6%), adjuvant (12.5%) or palliative (54.2%) chemotherapy was performed. Immunosuppressive regimen was modified from a calcineurin inhibitor (CNI)-based to an everolimus-based regimen (63.5% of CNI discontinuation). Median survival after diagnosis of malignancy was 22.5 months and 5-year survival was 30.1%. Chemotherapy regimen was considered optimal in 81.9% of the cases. Multivariate analysis disclosed that non-PTLD N+ stage malignancy (HR = 5.52 95%CI [1.40;21.69], p = .014), non-PTLD M+ stage malignancy (HR = 10.55 95%CI [3.20;34.73], p = .0001), and suboptimal chemotherapy (HR = 2.73 95%CI [1.34;5.56], p = .005) were significantly associated with poorer prognosis. No rejection episode occurred during chemotherapy. The present study is the first one focused on antineoplastic chemotherapy in LT recipients. Our results suggest that immunosuppressive drugs and antineoplastic chemotherapy can be managed satisfactorily in most cases but this needs confirmation from larger cohorts.
Sections du résumé
BACKGROUND
Malignancies are a major cause of late death after liver transplantation (LT). In LT recipients presenting a malignancy, antineoplastic chemotherapy is central part of the therapeutic arsenal, but management of both immunosuppressive and antineoplastic chemotherapy can be very challenging. The aim of the present retrospective study was to describe a recent single center cohort of LT recipients treated with antineoplastic cytotoxic chemotherapy.
METHODS
All LT recipients who received antineoplastic chemotherapy in our center between 2005 and 2021 were included.
RESULTS
The study population included 72 antineoplastic chemotherapy courses in 69 patients. There was a majority of men (81.9%); median age at LT was 54.9 (range 1-68) and was 63.0 (18-79) at the diagnosis of malignancy. Lung carcinomas (23.6%), head and neck carcinomas (20.8%), lymphomas (16.7%), and recurrent hepatocellular carcinoma (HCC) (8.3%) were the most frequent malignancies. Neoadjuvant (30.6%), adjuvant (12.5%) or palliative (54.2%) chemotherapy was performed. Immunosuppressive regimen was modified from a calcineurin inhibitor (CNI)-based to an everolimus-based regimen (63.5% of CNI discontinuation). Median survival after diagnosis of malignancy was 22.5 months and 5-year survival was 30.1%. Chemotherapy regimen was considered optimal in 81.9% of the cases. Multivariate analysis disclosed that non-PTLD N+ stage malignancy (HR = 5.52 95%CI [1.40;21.69], p = .014), non-PTLD M+ stage malignancy (HR = 10.55 95%CI [3.20;34.73], p = .0001), and suboptimal chemotherapy (HR = 2.73 95%CI [1.34;5.56], p = .005) were significantly associated with poorer prognosis. No rejection episode occurred during chemotherapy.
CONCLUSIONS
The present study is the first one focused on antineoplastic chemotherapy in LT recipients. Our results suggest that immunosuppressive drugs and antineoplastic chemotherapy can be managed satisfactorily in most cases but this needs confirmation from larger cohorts.
Identifiants
pubmed: 36394373
doi: 10.1111/ctr.14841
pmc: PMC10078502
doi:
Substances chimiques
Immunosuppressive Agents
0
Antineoplastic Agents
0
Calcineurin Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14841Informations de copyright
© 2022 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.
Références
Cancers (Basel). 2021 Mar 05;13(5):
pubmed: 33807849
Clin Transplant. 2023 Jan;37(1):e14841
pubmed: 36394373
Clin Transplant. 2014 Dec;28(12):1339-48
pubmed: 25081431
Liver Transpl. 2020 Nov;26(11):1465-1476
pubmed: 32869469
Liver Transpl. 2022 Jun;28(6):1063-1077
pubmed: 34919773
Clin Res Hepatol Gastroenterol. 2021 Jul;45(4):101514
pubmed: 33714907
Gastroenterol Clin Biol. 2009 Nov;33 Suppl 4:S263-7
pubmed: 20004333
Liver Transpl. 2005 Jan;11(1):89-97
pubmed: 15690541
Transplantation. 2007 Sep 27;84(6):786-91
pubmed: 17893613
Liver Transpl. 2018 Oct;24(10):1425-1436
pubmed: 30021061
Bull Cancer. 2017 Mar;104(3):245-257
pubmed: 28237352
Liver Transpl. 2019 Dec;25(12):1822-1832
pubmed: 31631501
Am J Transplant. 2010 Jun;10(6):1420-7
pubmed: 20486907
JAMA. 2011 Nov 2;306(17):1891-901
pubmed: 22045767
Liver Transpl. 2011 Aug;17(8):905-13
pubmed: 21384525
Transplant Rev (Orlando). 2016 Jul;30(3):161-70
pubmed: 27083870
Am J Transplant. 2020 Sep;20(9):2457-2465
pubmed: 32027461
Lancet Oncol. 2007 Oct;8(10):921-32
pubmed: 17913661
Ann Hepatol. 2022 Jan-Feb;27(1):100654
pubmed: 34929349
Liver Transpl. 2016 Oct;22(10):1367-78
pubmed: 27348086
Gastroenterology. 2012 Oct;143(4):986-94.e3; quiz e14-5
pubmed: 22750200
Nephron Clin Pract. 2012;120(4):c179-84
pubmed: 22890468
Transplant Rev (Orlando). 2022 Jan;36(1):100670
pubmed: 34688986
Am J Transplant. 2017 Jul;17(7):1843-1852
pubmed: 28133906
Liver Transpl. 2012 Nov;18(11):1277-89
pubmed: 22887956
Clin Transplant. 2011 Jul-Aug;25(4):660-9
pubmed: 21158921
Cancer Commun (Lond). 2020 Sep;40(9):461-464
pubmed: 32762027
Am J Transplant. 2016 Oct;16(10):2816-2835
pubmed: 27273869
Am J Gastroenterol. 2007 May;102(5):1032-41
pubmed: 17313502
Liver Transpl. 2021 Aug;27(8):1165-1180
pubmed: 33655645
Transplantation. 2017 Feb;101(2):239-251
pubmed: 27495768