WS03 – Cancer in pre and post transplant patients
Transplant recipients are at increased risk of cancer, particularly virus-induced cancer such as post-transplant lymphoproliferative disorders and Kaposi sarcoma, and those that are caused both by impaired immunosurveillance and by direct DNA damage by anti-rejection drugs themselves, such as skin and lip cancers. The treatment of those cancers may greatly benefit from immunosuppression reduction and and/or switch from calcineurin-based to mTOR-inhibitors based immunosuppression. However, change in immunosuppression may increase the risk of rejection and the risk of severe adverse events. Therefore, it is unclear in which patients, in which stages of cancer disease, and to what extent immunosuppressive regimes should be changed. On the other hand, there are cancers that do not have any clear link with anti-rejection treatment (such as lung, colon-rectum), because they have the same incidence as in the general population. In transplant recipients suffering from those cancers, it is even more difficult to decide upon what changes in immunosuppression should be carried out. The scenario recently became even more challenging after the introduction of cancer immunotherapy, such as that based on checkpoint inhibition, which represents the most important innovation in oncology. Cancer immunotherapy engages the patient’s own immune system against the tumor rather than targeting the cancer directly. Recipients of non-life saving organs such as kidney, and who suffer from advanced cancer may be considered eligible for treatment with these drugs. The question is how should maintenance anti-rejection treatment be reduced in order to let checkpoint inhibitors fully unleash T cells against cancer, but the same time minimize the risk of graft loss due to rejection, as activated T cells may destroy graft cells along with tumor cells.
Learning objectives: The aim of this workgroup is to establish a consensus on key questions concerning cancer in solid organ transplant recipients namely, what are the changes of immunosuppressive therapy that can currently be recommended in transplant recipients with solid organ cancers (excluding non-melanoma skin cancer) or PTLD.
Target group: Transplant physicians, oncologists, hematologists.
Leader: Umberto Maggiore
Group members: Rachel Hellemans (Belgium), Sylvain Choquet (France)
Forum moderators: Ilaria Galdolfini and Alessandra Palmisano
A series of short case studies will be discussed by the workstream group members on the Transplant Live open discussion board .Short quiz polls will be shared through the ESOT social media and results will guide and enhance the discussion on the open forum. The registration to the online forum is FREE and you can join by registering at this link
WS03 Report (20 min) + Live Q&A (10 min) 15 November, 14:15-15:15 CET
Focus on topic WS03 (15 min)+ Live Q&A (15 min) 15 November, 16:45-17:45 CET