Dr Cremolini on the Implications of the TRANSMET Trial in Colorectal Liver Metastases

Chiara Cremolini, MD, PhD, associate professor, medical oncology, University of Pisa; president, Gruppo Oncologico Nord Ovest (GONO), Fondazione GONO, discusses the implications of the TRANSMET trial (NCT02597348) evaluating chemotherapy and liver transplantation vs chemotherapy alone in patients with unresectable colorectal liver metastases.

One of the most significant recent developments in the field of colorectal cancer management is the TRANSMET trial, a study focusing on patients with liver-limited disease who were deemed unresectable, Cremolini begins. These patients were evaluated at baseline and again after receiving an upfront chemotherapy regimen. The trial enrolled 94 patients, who were randomly assigned into 2 groups. One group (n = 38) received only chemotherapy, and the other group (n = 36) received a liver transplantation following the chemotherapy, but only if they were confirmed unresectable according to standard surgical criteria, she reports.

The findings of the TRANSMET trial were remarkable, Cremolini explains. The trial demonstrated a significant advantage for patients in the liver transplantation group, particularly concerning 5-year overall survival (OS), which was the primary end point of the study, she says. This OS benefit was even more pronounced in the per-protocol population compared with the intention-to-treat population, according to Cremolini. Specifically, the hazard ratio in the intention-to-treat population was 0.37 (95% CI, 0.21-0.65), underscoring the clear benefit of liver transplantation for these patients, Cremolini emphasizes.

Liver transplantation, which has not traditionally been considered part of the treatment arsenal for patients with metastatic colorectal cancer (mCRC), now shows potential as a valuable treatment option for those with liver-limited disease, she continues. The results of this trial are likely to have far-reaching implications, as they indicate that liver transplantation should be considered during multidisciplinary evaluations of patients with mCRC with liver-limited disease, Cremolini adds.

Incorporating liver transplantation into the treatment of these patients represents a significant shift in how mCRC is managed, she notes. This new approach could offer improved outcomes for patients who previously had limited options, marking a critical advancement in the management of this disease, Cremolini concludes.