Michel Ducreux, MD, PhD, Chief of Gastrointestinal Oncology, Director of the Gastrointestinal Tumors Tumor Board, Gustave Roussy. A professor of oncology at Paris-Saclay University discusses the rationale for starting the TRANSMET trial (NCT02597348), which is evaluating chemotherapy, liver transplantation, and chemotherapy alone in patients with completely unresectable colorectal liver metastases. He also emphasized the importance of the findings from this trial.
For patients with liver metastases from colorectal cancer (CRC) and no other metastatic involvement, surgical resection may be curative; however, for patients with a large number of metastases, resection may be Dr. Ducroux says it may not be possible. In such cases, liver transplantation, as considered in TRANSMET, has emerged as a promising approach to improve survival outcomes, he says. This trial demonstrated that patients who underwent liver transplantation experienced superior survival outcomes compared to patients who continued chemotherapy alone.
With a median follow-up of 59 months, 5-year overall survival (OS) in the intent-to-treat population was 57% for patients who received transplantation, compared with only 13% for patients who received chemotherapy alone. (HR), 0.37; 95% CI, 0.21-0.65; P = .0003). In the on-protocol population, the survival benefit was even more pronounced, with 5-year OS of 73% in the transplant group versus 9% in the chemotherapy group (HR, 0.16; 95% CI, 0.07 ~0.33, log-rank P < .0001).
These results highlight the potential of liver transplantation as a treatment option for some patients with CRC liver metastases, Ducreux said. However, he emphasizes that careful patient selection is critical to success. Liver transplants must be performed only in well-selected candidates, Ducroux said, adding that the growing demand for liver transplants, which are also needed for benign liver diseases and hepatocellular carcinoma, is a challenge to resource management and equitable access. It added that it could also pose challenges in securing security. Therefore, although liver transplantation may be a viable treatment for this population of patients, the use of liver transplantation as a treatment requires balancing competing indications and maintaining rational allocation practices. Ducroux concludes that this requires careful management.
