Written by Mary Marschner
Spoon Feed
Liver transplantation plus chemotherapy in patients with adenocarcinoma with isolated, unresectable liver metastasis significantly improved five-year survival when compared to patients with only chemotherapy.
Synopsis
The TransMet trial, a multicenter randomized controlled study, assessed liver transplantation combined with chemotherapy versus chemotherapy alone for patients with unresectable colorectal liver metastases. At five years, overall survival was significantly higher for the transplantation group (56.6%) compared to chemotherapy alone (12.6%, p=0.0003). In the per-protocol analysis, survival reached 73.2% versus 9.3%, respectively (p<0.0001). Median progression-free survival was also superior in the transplantation group (17.4 months vs. 6.4 months, p<0.0001). Serious adverse events were comparable, confirming transplantation’s feasibility. These findings establish liver transplantation as a transformative option for select patients with unresectable colorectal liver metastases. [AI generated]
Are liver transplant lists about to get longer?
In the last 3 years, the recommendation for first-time colonoscopy has dropped from 50 to 45 because of an increase in the number of colon cancers. With this rise, it is important to be aware of different treatment options for our patients. If we can catch the cancer before metastasis, surgery can be curative, but once it has metastasized, the recommendations are chemotherapy and potentially resection of the mets. This article is looking at metastatic colorectal cancers with metastasis only to the liver that is unresectable and compared patients who received chemotherapy vs transplantation and chemotherapy. This study was lofty and very well done. Patient selection was meticulously reviewed and agreed upon by multiple oncologists, radiologists, and transplant surgeons before enrollment, and patients were approved for expedited transplantation despite not fitting into current criteria for transplantation. The primary endpoint was survival at 5 years, and this study showed that chemo with transplantation did better than chemo alone. However, progression of disease continued despite transplantation in all but 2 (7%) patients, demonstrating that transplantation with chemotherapy is unlikely to be curative. This study is unlikely to change my current practice, but keeps me updated on potential treatment options or updates to transplant indications in a rapidly growing oncology population.
Source
Liver transplantation plus chemotherapy versus chemotherapy alone in patients with permanently unresectable colorectal liver metastases (TransMet): results from a multicentre, open-label, prospective, randomised controlled trial. Lancet. 2024 Sep 21;404(10458):1107-1118. doi: 10.1016/S0140-6736(24)01595-2. PMID: 39306468
