Liver transplantation combined with chemotherapy offers a significant survival advantage for patients with definitively unresectable colorectal liver metastases (CRC), according to results from the TRANSMET trial (NCT02597348). The study, led by Michel Ducreux, MD, PhD, highlights a potential new treatment avenue for a subset of CRC patients for whom surgical resection is not feasible.
Superior Survival Outcomes with Transplantation
The TRANSMET trial compared outcomes of patients receiving chemotherapy alone versus chemotherapy followed by liver transplantation. At a median follow-up of 59 months, the intention-to-treat analysis revealed a 5-year overall survival (OS) rate of 57% for patients who underwent transplantation, compared to only 13% for those treated with chemotherapy alone (HR, 0.37; 95% CI, 0.21-0.65; log-rank P = .0003).
The survival benefit was even more pronounced in the per-protocol population, with 5-year OS rates of 73% in the transplantation group versus 9% in the chemotherapy group (HR, 0.16; 95% CI, 0.07-0.33; log-rank P < .0001).
Patient Selection and Resource Allocation
Dr. Ducreux emphasized the importance of careful patient selection for liver transplantation. "Liver transplantation must be reserved for well-chosen candidates," he stated. The increasing demand for liver transplants for various conditions, including benign liver diseases and hepatocellular carcinoma, poses challenges in resource management and equitable access. Balancing the potential benefits for CRC patients with other critical needs requires careful consideration.
Implications for CRC Treatment
These findings suggest that liver transplantation could be a viable treatment option for select patients with CRC liver metastases. However, its use must be carefully managed to balance competing indications and maintain reasonable allocation practices. Further research is needed to refine patient selection criteria and optimize the integration of liver transplantation into the treatment paradigm for CRC liver metastases.
