Dr Adam on Efforts to Reduce Recurrence Risk in CRC Liver Metastases

Transplantation, Paul Brousse Hospital, Villejuif, France, discusses future research directions aimed at reducing the risk of recurrence in patients with unresectable colorectal liver metastases following findings from the prospective, multicenter, randomized TRANSMET trial (NCT02597348).

Findings from TRANSMETpresented at the 2024 ASCO Annual Meeting indicated that patients with liver metastases from CRC who underwent liver transplantation in addition to chemotherapy experienced improved overall survival (OS) vs those given chemotherapy alone. The 5-year OS rate for patients in the intention-to-treat population receiving liver transplantation plus chemotherapy (n = 47) was 57% vs 13% for those given chemotherapy alone (n = 47; HR, 0.37; 95% CI, 0.21-0.65; P = .0003). In the per protocol population, the 5-year OS rates were 73% for liver transplant plus chemotherapy (n = 36) vs 9% for chemotherapy alone (n = 38; HR, 0.16; 95% CI, 0.07-0.33; P < .001).

Despite these data that could support a potential shift in the standard of care for patients with liver metastases from CRC, Adam explains that the risk of recurrence remains high, a challenge for this patient population. He emphasizes that future research should focus on incorporating liver transplantation into the standard treatment options for highly selected patients with liver metastases from CRC, which could improve survival outcomes for these patients However, Adam notes that the recurrence rate post-transplantation presents a significant challenge, underscoring the need for novel strategies to identify and mitigate recurrence risks.

One key area of research Adam highlights is the identification of molecular and biological markers that could predict which patients are more likely to experience recurrence. By understanding the underlying mechanisms driving recurrence, clinicians could potentially tailor treatment plans to individual patients, improving long-term outcomes, Adam explains.

Additionally, Adam notes that further research should explore the feasibility of combining surgical and non-surgical approaches, such as systemic therapies, to better manage the disease and prevent recurrence. By integrating these strategies, the goal is to not only extend survival but also to enhance the quality of life for patients with liver metastases from CRC, Adam concludes.