Dr Ducreux on the Potential Use of Liver Transplantation Plus Chemo for CRC Liver Metastases

Michel Ducreux, MD, PhD, head, Gastrointestinal Oncology Unit, head, Gastrointestinal Oncology Tumor Board, Gustave Roussy; professor, oncology, Paris-Saclay University, discusses the rationale for launching the TRANSMET trial (NCT02597348) evaluating chemotherapy plus liver transplantation vs chemotherapy alone in patients with definitively unresectable colorectal liver metastases. He also goes on to highlight the significance of findings from the trial.

In patients with liver metastases from their colorectal cancer (CRC) without other metastatic involvement, surgical resection may potentially offer a cure, but for those with a large number of metastases, resection may not be feasible, Ducreux begins. For such cases, liver transplantation has emerged as a promising approach to improve survival outcomes, as explored in TRANSMET, he says. The trial demonstrated that patients undergoing liver transplantation experienced superior survival outcomes compared with those who continued chemotherapy alone.

At a median follow-up of 59 months, the 5-year overall survival (OS) rate in the intention-to-treat population was 57% for those who underwent transplantation, compared to just 13% for patients who received chemotherapy alone (HR, 0.37; 95% CI, 0.21-0.65; log-rank P = .0003). In the per-protocol population, the survival benefit was even more pronounced, with 5-year OS rates of 73% in the transplantation group vs 9% in the chemotherapy group (HR, 0.16; 95% CI, 0.07-0.33; log-rank P < .0001).

These results underscore the potential of liver transplantation as a treatment option for select patients with CRC liver metastases, Ducreux states. However, careful patient selection is critical for success, he emphasizes. Liver transplantation must be reserved for well-chosen candidates, Ducreux says, adding that the growing demand for liver transplants, which are also needed for benign liver diseases and hepatocellular carcinoma, could also pose challenges in the management of resources and ensuring equitable access. Therefore, liver transplantation could be a viable treatment for patients in this population, but its use as a treatment must be carefully managed to balance competing indications and maintain reasonable allocation practices, Ducreux concludes.