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 

 = .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 

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.

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Michel Ducreux, MD, PhD, discusses the rationale for the TRANSMET trial in patients with CRC liver metastases, highlighting the significance of data from the trial.

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

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 

 = .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 

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.

Michel Ducreux, MD, PhD, discusses findings from the TRANSMET trial of chemotherapy plus liver transplantation in unresectable colorectal liver metastases.

Michel Ducreux, MD, PhD

Articles

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

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