Liver transplantation is a promising option for patients with liver metastases from colorectal cancer – Advances in Gastrointestinal Surgery, Oncology, and Transplantation

New tools to monitor recurrence

An essential new tool being incorporated into this process is a test called a liquid biopsy, which differs from a tissue biopsy in that it uses a non-invasive blood draw to collect tumor DNA circulating in a patient's blood. Also known as circulating tumor DNA (ctDNA) testing, this technology allows doctors to quickly and easily determine the genetic makeup of a cancer and track its progression over time.

“Colon cancer releases a lot of DNA into the bloodstream, which can be captured by liquid biopsy,” he says. Pashtun Kashi, MDHe is an oncologist and director of liquid biopsy research at the Englander Institute for Precision Medicine at NewYork-Presbyterian College.“This technology will allow us to genomically identify the type of colon cancer patients have and the mutations that make up their colon cancer, and in addition to imaging and other tools, we will be able to monitor the progress of treatment,” said Professor Weill Medical College of Cornell University, a pioneer of the technology.

One of the benefits of liquid biopsies is that they can help determine whether all of the cancer has been removed from a patient's body after a procedure aimed at removing it. “There may be small pieces of cancer remaining that are below the resolution of the imaging tests we use to decide whether to do surgery or a transplant,” explains Dr. Rocca.

Dr. Kasi adds, “The key to success will be selecting the right patients who will benefit most from this approach. It is important to test over time to ensure the cancer is well controlled. Additionally, integrating these liquid biopsies can help evaluate disease burden and ongoing response to treatment, where traditional tumor markers such as CEA and CA-19-9 are not always reliable. Additionally, these liquid biopsy assays can also be used in the post-transplant surveillance setting. We are one of the few centers using this as another tool in the toolbox for these patients.”

This interdisciplinary collaboration and ongoing evaluation is crucial.At Weill Cornell Medicine, biweekly meetings are held to discuss every potential patient pre- and post-transplant with all the key people involved. Dr. Rocca is confident that liver transplants for this common cancer indication will continue to grow, but he recognizes there is a liver shortage and long waiting lists.

“We are cautious when we expand the standard of care for liver cancer because cancer will come back,” Dr. Rocca said, “and we start to think that we should give this precious gift of life to someone else. That's why we're going slowly and carefully with liver cancer transplants.”

Dr. Kashi added: “In some circumstances, undergoing a transplant may preclude future clinical trials or other options, so the decision is not simple but will be a process of overselection to identify patients who would benefit most from such an approach.”