Clinical outcomes of systemic anticancer therapies in solid cancer patients with liver and kidney transplant: an observational cross-sectional study

Background: Solid cancer patients with liver transplant (LT) or kidney transplant (KT) receiving systemic anticancer therapies (SACT) are likely to present an increased risk of treatment-related infections.We aimed to describe their clinical outcomes.Patients and methods: This retrospective study included SACT-treated patients from two university medical oncology centers between 2000 and 2023, identified through automated extraction and manual record review.We excluded patients treated with immune checkpoint inhibitors.We manually collected immunosuppressant and SACT administration, patient SACT grade 3 to 5 toxicities, cause of death, and overall survival.Results: Fifty-three patients were included: 39 (74%) men, 33 (62%) LT, and 20 (38%) KT; median age was 62 years (interquartile range 32-82 years); 19 (58%) and 15 (75%) LT and KT patients, respectively, had stage IV diseases.Primary cancer was liver (n = 16; 45%) and digestive (n = 10; 30%) for LT patients; digestive (n = 7; 35%), kidney, breast, and lung (all three n = 3; 15%) for KT patients.From the time before cancer diagnosis to SACT administration, the immunosuppressant regimen was changed in both subgroups.Overall, 29 (88%) LT patients and 17 (85%) KT patients were exposed at least once to standard cytotoxic drugs, and 8 (24%) LT patients and 3 (15%) KT patients to tyrosine kinase inhibitors.Thirty-three patients had grade 3-4 toxicities, 52% LT patients and 30% KT patients.Twenty-four patients had grade 5 toxicities (79% LT and 86% KT patients treatment-related infections, respectively).One-year overall survival rates were 52% for LT patients and 50% for KT patients.After treatmentrelated infections, death was due to tumor progression for 9 LT patients (32%) and 5 (42%) KT patients, respectively.Conclusions: Treatment-related infections drive the prognosis of LT and KT patients undergoing SACT.