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). 

 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; 

 = .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; 

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.

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Rene Adam, MD, PhD, discusses future research aimed at reducing the risk of recurrence in patients with unresectable colorectal liver metastases

Dr Adam on the Efficacy of Liver Transplantation With Chemo in Unresectable CRC Liver Metastases

Rene Adam, MD, PhD, head, Department of Hepato-Biliary Surgery, Cancer and Transplantation, Paul Brousse Hospital, Villejuif, France, discusses the efficacy of chemotherapy with liver transplantation in patients with definitively unresectable colorectal liver metastases (uCLM), according to data from the TRANSMET trial (NCT02597348).

The prospective randomized trial compared treatment with liver transplantation plus chemotherapy with chemotherapy alone in patients with uCLM from resected BRAF non-mutated colorectal cancer, who responded to no more than 3 lines of chemotherapy for at least 3 months in the absence of extrahepatic disease.

 showed that patients with uCLM undergoing liver transplantation in addition to chemotherapy experienced greater survival benefit vs those receiving chemotherapy alone, Adam reports. Analysis of 5-year OS in the per protocol population (n = 74) showed a significant increase from 9% with chemotherapy to 73% with the added intervention, translating to an 84% reduction in the risk of death, (HR, 0.16; 95% CI 0.07-0.33; 

 < .0001), he details. This exceeded the hypothesized 5-year OS rates of 50% and 10% with transplantation vs chemotherapy alone, respectively. 

At a median follow-up of 59 months, the 5-year overall survival (OS) rate in the intention-to-treat population (n = 94) was 57% with the added intervention vs 13% with chemotherapy alone (HR, 0.37; 0.21-0.65; 

 = .0003). Three- and 5-year progression-free survival rates per protocol with the combination were 33% and 20%, respectively; these were 4% and 0%, respectively, in the chemotherapy-alone arm (HR, 0.34; 0.20-0.57; 

Moreover, patients who underwent transplantation in this study population experienced similar survival outcomes to that of patients who underwent liver transplant for other established indications, Adam notes.

He explains that these results were obtained due to drastic patient selection, good disease control, and a prioritization of transplant for patients within 2 months after inclusion onto the study. Overall, these findings support the administration of liver transplantation plus chemotherapy as a potential curative treatment for patients with otherwise poor long-term outcomes.

Rene Adam, MD, PhD, discusses the use of chemotherapy and liver transplant in patients with definitively unresectable colorectal liver metastases.

Rene Adam, MD, PhD

Articles

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

Dr Adam on the Efficacy of Liver Transplantation With Chemo in Unresectable CRC Liver Metastases