P1.06-039 Retrospective Study of the Incidence and Outcomes from Lung Cancer That Developed Following a Solid Organ Transplant

Abstract

Organ transplant recipients (OTR) have an increased risk of developing post-transplant malignancies with lung cancer being one of the most common. We investigated incidence and outcomes of lung cancer in OTR managed at the University Health Network. The study population, patient characteristics, treatments and outcomes were summarized from solid OTR databases, our cancer registry and patient charts from January 1, 1980 to December 31, 2015. Univariate Kaplan-Meyer curves estimated overall survival (OS) by histology, stage and chemotherapy. Amongst 7994 OTR (heart [N=765], lung [n=1668], liver [n=238], kidney [n=3273]), 123 developed lung cancer (1.54%) of which (55) 44.7% occurred in lung OTR; 108 (1.35%) patients had sufficient data for subsequent analyses. Median age: 62 years (29 - 85); male: 66%; smoking status at time of transplant - former/current/never/unknown: 62%/10%/15%/8%. Histologies included non-small cell lung cancer (NSCLC): 81%; small cell lung cancer (SCLC): 10%; neuro-endocrine tumors: 9%. NSCLC: Adjuvant chemotherapy, after it became standard of care (SOC), was given to 16% of eligible NSCLC patients. At recurrence, 28% received chemotherapy while 28% received a TKI. In patients initially presenting with stage IV NSCLC, 18% received chemotherapy and 3% received a TKI. SCLC: For limited and extensive stage SCLC patients, 83% and 60% received SOC chemotherapy, respectively. All: Where chemotherapy dosing was known (n=23), 42% of patients received initial dose reductions. For early stage patients, 22% required dose reduction and 11% had chemotherapy discontinuation due to toxicity. For stage IV patients, 42% required dose reductions and 50% required discontinuations.Tabled 1Median OS by SubgroupPatients by Histology, Stage at Diagnosis & Systemic Treatmentnmedian OS (months)95% C.I.NSCLC: Stage I/II•Systemic Treatment•No treatment48 11 3724.9 25.7 24.9(17.3-36.6) (14-51.6) (16.2-72.9)NSCLC: Stage III•Systemic Treatment•No treatment7 1 624.6 84.0 24.6(4.5-NA) NA (4.5-NA)NSCLC: Stage IV•Systemic Treatment•No treatment33 7 263.2 8.7 2.3(2-4) (4.7-52.4) (1.5-3.5)SCLC: Limited Stage•Systemic Treatment•No treatment6 5 19.6 14.3 2.0(2-NA) (8.4-NA) NASCLC: Extensive Stage•Systemic Treatment•No treatment5 3 21.7 5.5 0.2(0.2-NA) (1.7-NA) (0.2-NA) Open table in a new tab Survival was poor in our OTR population compared to historical norms in non-transplant patients. A minority of NSCLC patients received adjuvant or palliative chemotherapy, while most SCLC patients were treated. Both often had sub-standard dosing. Chemotherapy appeared better tolerated in early stage disease.