Abstract
Simple SummaryTransplant oncology is an emerging field in cancer treatment that applies transplant medicine, surgery, and oncology to improve cancer patient survival and quality of life. This review aims to provide a comprehensive overview of the history and emergence of cfDNA technology, its applications to specifically monitor tumor burden at pre-and post-liver transplant stages, and evaluate transplant rejection. The use of ctDNA to evaluate transplant rejection has been extensively studied in non-hepatocellular carcinoma (HCC) diseases. Emerging studies have also investigated the use of ctDNA detection in evaluating HCC tumor burden pre-and post-surgery as well as transplant rejection. However, extensive studies still need to be conducted to evaluate the role of ctDNA detection in the medical management of transplant oncology patients.Transplant oncology is an emerging field in cancer treatment that applies transplant medicine, surgery, and oncology to improve cancer patient survival and quality of life. A critical concept that must be addressed to ensure the successful application of transplant oncology to patient care is efficient monitoring of tumor burden pre-and post-transplant and transplant rejection. Cell-free DNA (cfDNA) detection has emerged as a vital tool in revolutionizing the management of cancer patients who undergo organ transplantation. The advances in cfDNA technology have provided options to perform a pre-transplant evaluation of minimal residual disease (MRD) and post-transplant evaluation of cancer recurrence and transplant rejection. This review aims to provide a comprehensive overview of the history and emergence of cfDNA technology, its applications to specifically monitor tumor burden at pre-and post-transplant stages, and evaluate transplant rejection.
Highlights
Introduction to Transplant OncologyTargeting cancer has been a highly personalized therapeutic and multidisciplinary effort aimed at normalizing organ function, sustaining quality of life, and controlling cancer burden
Common biomarkers that are assessed in Cellfree DNA (cfDNA) for cancer surveillance pre-transplant in hepatocellular carcinoma (HCC) patients include hotspot mutations of TP53, TERT, CTNNB1, VEGF amplification, copy number variants (CNV), and single nucleotide variants (SNV) [104,105,106,107,108,109,110,111]
Droplet digital polymerase chain reaction was performed on circulating tumor DNA (ctDNA) collected from 95 HCC patients and 45 liver cirrhotic patients without HCC for TERT C228T mutation
Summary
Introduction to Transplant OncologyTargeting cancer has been a highly personalized therapeutic and multidisciplinary effort aimed at normalizing organ function, sustaining quality of life, and controlling cancer burden. Transplant oncology is an emerging field in which transplant medicine, oncology, and surgery merge to help improve the survival outcomes, quality of life in patients, and enhance our understanding of hepatobiliary cancers [1]. Hepatobiliary malignancies, such as hepatocellular carcinoma (HCC), have been treated with liver transplantation, leading to improved survival outcomes relative to other standard-of-care treatment approaches [1]. Previous papers have suggested that transplant oncology can significantly contribute to treatment and research of hepatobiliary malignancies by (1) enhancing the evolution of a multidisciplinary cancer care approach that may help overcome limitations to current surgical techniques, (2) engaging the fields of tumor biology and transplant immunology together to pursue translational research on self and non-self-recognition, (3) exploring genomic mechanisms of carcinogenesis and innovative outcome endpoints, and (4) applying innovative transplantation techniques to surgical oncology [1,2]
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