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.

Data presented at the 2024 ASCO Annual Meeting 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; P < .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; P = .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; P < .0001).

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.