Lung cancer not uncommon after kidney transplant

While lung cancer is relatively rare among kidney transplant recipients, it remains a dangerous complication, carrying high rates of metastasis and mortality, according to a Philippine case series presented at the recently concluded 2020 Asia Virtual Congress of the European Society of Medical Oncology (ESMO Asia 2020)

“Kidney transplant recipients have increased risk of malignancy,” the researchers said. “Lung cancer is the leading cause of mortality among all cancer types in the general population.”

“There is a paucity of data in managing [transplant recipients] who develop lung cancer; hence, this study aims to provide information on lung cancer incidence, profiles of cases, and outcomes of the cancer-specific management,” they added.

Between 1983 and 2019, a total of 6,880 patients were able to receive kidney transplants from the National Kidney and Transplant Institute. Of these, five eventually developed lung cancer, yielding an overall malignancy incidence rate of 0.07 percent. The medical records of these five patients were reviewed and included in the present retrospective case review. [ESMO Asia 2020, abstract 414P]

Three of the patients presented with coughs and one with cervical lymphadenopathy. In these patients, lung cancer was already at stage IV when it was diagnosed. In the final patient, the malignancy was detected at a relatively early stage, IIB, through a routine chest x-ray. None of the patients had undergone low-dose chest computed tomography after kidney transplantation.

All four patients who had been diagnosed symptomatically already had at least one site of metastasis; the tumour had metastasized to two sites in one patient and to four sites in another. Detected sites of metastasis included the cervical lymph nodes, the liver, the adrenal gland, the bones, and the brain. In addition, pleural effusion was detected in three of these stage IV patients.

The patient who had been diagnosed at an earlier stage showed no evidence of metastasis or pleural effusion.

In terms of outcomes, four of the patients died, while one was lost to follow-up. Both the overall and progression-free survival was 3.4 months. The stage IIB patient underwent relapse 6.5 months after initial cancer diagnosis and eventually died due to progressive disease. In another patient, acute respiratory distress syndrome was identified as the cause of death.

Two patients initially showed good response to treatment, but nevertheless succumbed to cancer complication. One patient achieved stable disease after 6 cycles of chemotherapy, but eventually developed brain metastasis prior to death. Another patient achieved partial treatment response after 3 cycles but died due to hospital-acquired pneumonia after the fourth chemotherapy cycle.

“Additional studies are needed to determine the association of systemic treatment and survival, as well as adverse reactions to treatment, particularly in kidney transplant recipients,” the researchers said.