René Adam, MD, PhD, Head of the Department of Hepatobiliary Surgery, Cancer and Transplantation, Paul Bruss Hospital, Villejuif, France, will discuss the efficacy of chemotherapy with liver transplantation for patients with completely unresectable colorectal liver metastases (uCLM), based on data from the TRANSMET trial (NCT02597348).
This prospective randomized trial compared treatment with liver transplantation plus chemotherapy with chemotherapy alone in patients with uCLM after resection of colorectal cancer without BRAF mutation, who had no extrahepatic disease and responded to three or fewer chemotherapy lines for at least 3 months.
Presented data in 2024 ASCO Annual Meeting According to Adam, uCLM patients who received a liver transplant in addition to chemotherapy were shown to have a greater survival benefit than those who received chemotherapy alone. Analysis of 5-year OS in the per-protocol population (n = 74) showed a significant increase from 9% in those who received chemotherapy to 73% in those who received the additional intervention, resulting in an 84% reduction in the risk of death (HR, 0.16; 95% CI, 0.07-0.33). P (< .0001), he detailed, which exceeded the assumed 5-year OS rates of 50% and 10% for transplant and chemotherapy alone, respectively.
With a median follow-up of 59 months, 5-year overall survival (OS) in the intention-to-treat population (n = 94) was 57% in the additional intervention group and 13% in the chemotherapy-alone group (HR, 0.37; 0.21-0.65; P Per-protocol 3- and 5-year progression-free survival rates with the combination were 33% and 20%, respectively, compared with 4% and 0%, respectively, in the chemotherapy-alone arm (HR, 0.34, 0.20-0.57; P < .0001).
Additionally, patients who underwent transplants in this study population experienced survival outcomes similar to those undergoing liver transplants for other established indications, Adam noted.
These results were achieved through thorough patient selection, good disease management, and prioritization of transplant for patients within two months of study enrollment, he explained. Overall, these results support the implementation of liver transplantation combined with chemotherapy as a potentially curative treatment for patients with poor long-term outcomes.
