Carcinoma of the lung after heart transplantation.

We have recently noted an unexpected high incidence of lung cancer in our population of cardiac allograft recipients. We conducted a retrospective review of cardiac transplantation at our institution to investigate the incidence, clinical course, and outcome of patients who developed lung cancer following heart transplantation. Nine patients--each with a history of smoking at 30 pack-years--developed lung cancer following heart transplantation, for an incidence of 1.56% of patients at risk. Eight of the patients were male > or = 50 years of age, representing 3.3% of the male transplant recipients in this age group. The interval from transplantation to diagnosis clustered around 3-5 years after transplantation, but in two instances (22%), a neoplasm was discovered within 6 months of transplantation. Almost half of the cancers were discovered incidentally, despite routine radiographic surveillance. Seven of 9 (78%) patients had stage IV disease at presentation. Median survival after diagnosis was 3 months, and five of the seven patients who died survived less than 4 months after diagnosis. We conclude that cardiac transplant recipients are at increased risk for development of lung cancer. Patients with a moderate to heavy smoking history might well be advised to undergo chest CT scanning in an aggressive search for occult lung cancer before cardiac transplantation is considered further. Finally, despite frequent radiologic examinations, these lung cancers are often diagnosed incidentally, are far advanced at the time of diagnosis, are not surgically resectable, and are poorly responsive to adjuvant therapy.

Phase II evaluation of metoprine in patients with non-small-cell lung carcinoma.

A phase II study of metoprine in low dose and in high dose with citrovorum rescue was conducted in patients with non-small-cell lung carcinoma. There were no responses observed in the 36 patients studied, yielding a predicted true response rate of less than 9%. Thrombocytopenia was the dose-limiting toxicity of the low-dose regimen; there was also one episode of leukopenia and sepsis in this group. Although citrovorum rescue obviated hematologic toxicity in the high-dose regimen, mild to moderate neurological toxicity occurred at this dose. Metoprine does not appear to be a useful agent in non-small-cell lung carcinoma when used in the dose schedule employed in this study.