Dr Ducreux on Findings From the TRANSMET Trial in Colorectal Liver Metastases

Michel Ducreux, MD, PhD, head, Gastrointestinal Oncology Unit, head, Gastrointestinal Oncology Tumor Board, Gustave Roussy; professor, oncology, Paris-Saclay University, discusses findings from the TRANSMET trial (NCT02597348) investigating chemotherapy plus liver transplantation vs chemotherapy alone in patients with definitively unresectable colorectal liver metastases.

This trial randomly assigned 47 patients to undergo liver transplantation and 47 patients to continue chemotherapy alone. Some patients had disease progression before transplantation; accordingly, per-protocol populations consisted of 36 patients who received transplantation and 38 patients who received continuation chemotherapy alone. At a median follow-up of 59 months, the 5-year overall survival (OS) rate in the intention-to-treat population was higher for patients who underwent transplantation vs chemotherapy alone, at 57% vs 13% (HR, 0.37; 95% CI, 0.21-0.65; log-rank P = .0003). The 5-year OS rates in the per-protocol population were 73% and 9% in the transplantation and chemotherapy alone arms, respectively (HR, 0.16; 95% CI, 0.07-0.33; log-rank P < .0001).

Liver transplantation necessitates the administration of immunosuppressive drugs to allow the body to accept the new liver, Ducreux says. TRANSMET investigators noted that this immunosuppression might increase recurrence rates among the patients who received liver transplants, he explains. However, the administration of immunosuppressive drugs did not negatively impact patient outcomes in this arm, he emphasizes. At a median follow-up of 50 months, 72% of patients in the transplantation arm had disease recurrence compared with 97% of those in the chemotherapy alone arm. However, most recurrences in the transplantation arm were amenable to surgery or other curative measures, according to Ducreux. In the transplantation arm, recurrences were observed in the liver (n = 1), lungs (n = 14), lymph nodes (n = 3), other sites (n = 5), and multiple sites (n = 3). Overall, 46% of patients in this arm underwent surgery or ablation upon recurrence. In total, 42% of patients in this arm were ultimately disease free vs 3% of those in the chemotherapy alone arm. Overall, patients who underwent liver transplantation experienced superior survival outcomes to those who received continuation chemotherapy alone in the TRANSMET trial, he concludes.