Transplant Oncology: An Evolving Field in Cancer Care.

Rafik Mark Ghobrial,Ala Abudayyeh,Robert McMillan,Ashish Saharia,Maen Abdelrahim,A. Osama Gaber,Naoka Murakami,Linda W. Moore,Joy V. Nolte Fong,Sudha Kodali,Akshay Shetty,Kirk Heyne,Abdullah Esmail,David Victor

doi:10.3390/cancers13194911

Abstract

Simple SummaryTransplant oncology is an emerging concept of cancer treatment with a promising prospective outcome. The application of oncology, transplant medicine, and surgery to improve patients’ survival and quality of life is the core of transplant oncology. This review illustrates the concept and history of transplant oncology as an evolving field for the management of hepatocellular carcinoma, intrahepatic biliary cancer, and liver-only metastasis of non-hepatobiliary carcinoma. The utility of immunotherapy in the transplant setting is discussed as well as the feasibility of using circulating tumor DNA for surveillance post-transplantation. As transplant oncology continues to evolve as a promising field in cancer management, it is expected that there will be improved outcomes and expansion of transplant eligibility through the consolidation of multidisciplinary and collaborative efforts. Liver transplantation is increasingly associated with improved survival outcomes in patients with liver malignancies. Eligibility criteria for liver transplantation has expanded over the years to include more patients with cancer. In addition, immunotherapy and ctDNA are two emerging concepts that are highly applicable to transplant oncology treatment. Immunotherapy may be used as neoadjuvant “bridging” therapy pre- liver transplantation and possibly in the palliative setting post-transplantation. Liquid biopsy to assess ctDNA post-transplantation can potentially be used as a biomarker to detect minimal residual disease and disease recurrence.Transplant oncology is an emerging concept of cancer treatment with a promising prospective outcome. The application of oncology, transplant medicine, and surgery to improve patients’ survival and quality of life is the core of transplant oncology. Hepatobiliary malignancies have been treated by liver transplantation (LT) with significant improved outcome. In addition, as the liver is the most common site of metastasis for colorectal cancer (CRC), patients with CRC who have stable unresectable liver metastases are good candidates for LT, and initial studies have shown improved survival compared to palliative systemic therapy. The indications of LT for hepatobiliary malignancies have been slowly expanded over the years in a stepwise manner; however, they have only been shown to improve patient survival in the setting of limited systemic therapy options. This review illustrates the concept and history of transplant oncology as an evolving field for the management of hepatocellular carcinoma, intrahepatic biliary cancer, and liver-only metastasis of non-hepatobiliary carcinoma. The utility of immunotherapy in the transplant setting is discussed as well as the feasibility of using circulating tumor DNA for surveillance post-transplantation.

Highlights

Transplant oncology is an evolving concept of cancer treatment with a promising prospective outcome
Sapisochin et al [42] have reported that in patients with "advanced" disease the 1-year, 3-year, and 5-year actuarial survival rates after LT were 79%, 50%, and 45%, respectively. These findings suggest that patients with cirrhosis and very early intrahepatic cholangiocarcinoma (IHCCA) may become candidates for liver transplantation
The Circulating Tumor DNA (ctDNA) biopsy reveals a dynamic picture of Hepatocellular carcinoma (HCC), is repeatable when needed, and provides real-time surveillance for minimal residual disease in HCC patients

Summary

Introduction

Transplant oncology is an evolving concept of cancer treatment with a promising prospective outcome. Hepatocellular carcinoma (HCC), the most common liver malignancy [1], has been treated by transplantation with excellent outcomes. Hepatobiliary cancer management and research can benefit from integrating the principles of transplant oncology in an attempt to use current knowledge to guide future opportunities. Liver transplantation (LT) for selected liver malignancies is the only solid organ transplant with noticeable efficacy in curing cancer. Transplant oncology can potentially contribute to the treatment and research of hepatobiliary malignancies in four ways: ref. [1] exploring a new concept of cancer treatment that includes LT, ref. [2] connecting tumor and transplant immunology and pursuing translational research in self and non-self-recognition, ref. Transplant oncology can potentially contribute to the treatment and research of hepatobiliary malignancies in four ways: ref. [1] exploring a new concept of cancer treatment that includes LT, ref. [2] connecting tumor and transplant immunology and pursuing translational research in self and non-self-recognition, ref. [3] developing innovative clinical and experimental standards for accessing and exploiting the explanted liver, and ref. [4]

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