Published online Mar 28, 2022. doi: 10.4329/wjr.v14.i3.60
Peer-review started: October 11, 2021
First decision: December 10, 2021
Revised: December 20, 2021
Accepted: March 15, 2022
Article in press: March 15, 2022
Published online: March 28, 2022
Processing time: 164 Days and 23.4 Hours
Cancer is the second most common cause of mortality and morbidity in kidney transplant recipients. Immunosuppression can influence the efficacy of cancer treatment and modification of the immunosuppressive regimen may restore anti-neoplastic immune responses improving oncologic prognosis. However, patients are usually reluctant to modify their immunosuppression, fearing rejection and potential graft loss.
To develop reference points for guiding the transplant professionals in the clinical decision-making process and to improve the management of kidney transplant recipients with cancer.
Little evidence is available on radiotherapy management of cancer in kidney transplant recipients; in certain instances (e.g., in case of pelvic cancer or cancer of the transplanted kidney) it is also unclear which could be the best loco-regional treatment option, among the full range of ablative devices/ techniques, to be used as an alternative to nephron sparing surgery, currently the preferred option.
The overall process included: (1) The formulation of one specific question based on the Population, Intervention, Comparison, and Outcomes methodology; (2) Systematic literature review and summary for experts for each question; and (3) Extracted data were narratively synthesized and, where possible, frequencies, percentages, and ranges were calculated.
There is still no clear evidence that withdrawing anti-metabolites and/or calcineurin inhibitor and/or mammalian target of rapamycin inhibitors as opposed to continuing maintenance immunosuppression might improve patient survival in kidney transplant recipients with cancer undergoing radiotherapy. There are few retrospective studies on small cancer cohorts undergoing radiotherapy, especially prostate, without comparison of different immunosuppressive treatments. The radiation therapy can be performed with excellent oncological outcomes. No studies have compared different immunosuppressive treatment, and, when the immunosuppressive drugs are reported, patients’ survival seems to be correlated only with cancer stage or type. In addition, there are no data on the eventual effects of immunosuppressive drugs, especially mammalian target of rapamycin inhibitors, on the healing of radiotherapy-induced skin toxicity.
Although all the statements of the consensus are not methodologically evidence-based and their strength might therefore be questionable, they represent a starting point to orient transplant physicians in their everyday practice, and, above all, these statements clearly indicate the points that need to be addressed in the clinical research in this setting.
Prospective studies or pooled analyses are needed to define the proper treatment for this very selected group of patients.