73% of Patients Survive Beyond 5 Years: A New Treatment Option for Colorectal Cancer

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73% of Patients Survive Beyond 5 Years: A New Treatment Option for Colorectal Cancer

73% of Patients Survive Beyond 5 Years: A New Treatment Option for Colorectal Cancer

The liver is the primary target for bloodborne metastases in colorectal cancer, making liver metastasis a key challenge in clinical treatment. Around 15% to 25% of colorectal cancer patients are already diagnosed with liver metastasis at the time of their initial diagnosis, and 80% to 90% of these metastases are not amenable to curative resection. Liver metastasis remains one of the leading causes of death in colorectal cancer patients, with a 5-year survival rate of less than 5% for those whose metastases cannot be surgically removed.

For most patients with unresectable colorectal cancer liver metastasis, systemic chemotherapy has been the standard treatment. Previous studies indicated that the 5-year survival rate could reach 60% when combining chemotherapy with liver transplantation. However, several questions remained, such as whether the combination of chemotherapy and liver transplantation offers a survival benefit over chemotherapy alone.

Against this backdrop, researchers conducted the TransMet study, aiming to evaluate the benefits of chemotherapy alone versus chemotherapy combined with liver transplantation in patients with unresectable colorectal cancer liver metastasis

. Recently published in The Lancet, the results of the TransMet study showed that patients receiving the combination of chemotherapy and liver transplantation had a 5-year survival rate of 73.2%, supporting liver transplantation as a new treatment option for patients with unresectable liver metastasis.

73% of Patients Survive Beyond 5 Years: A New Treatment Option for Colorectal Cancer

TransMet Study: Key Findings

The TransMet study was a multicenter, open-label, prospective, randomized controlled trial conducted at 20 medical centers, enrolling 94 patients with unresectable colorectal cancer liver metastasis. Patients were randomized in a 1:1 ratio to receive either chemotherapy plus liver transplantation (47 patients) or chemotherapy alone (47 patients). Of these, 36 patients in the transplant group and 38 patients in the chemotherapy group adhered to the treatment protocols.

Both groups had a median number of 20 liver metastases at diagnosis. Before randomization, patients had undergone a median of 21 chemotherapy cycles in the transplant group and 17 in the chemotherapy-only group. Additionally, 15% (14/94) of patients had previously undergone liver resection. Severe toxicity (grade 3 or higher) occurred in 13% of patients in the transplant group and 17% in the chemotherapy group between the last chemotherapy cycle and randomization. After randomization, 81% (38/47) of patients in the transplant group underwent liver transplantation within a median of 50.5 days.

At a median follow-up of 59.3 months, a total of 56 patients had died. The median overall survival had not been reached in the transplant group, while it was 29.7 months in the chemotherapy group. The 5-year overall survival rate was significantly higher in the transplant group (56.6% vs. 12.6%), with a 63% reduction in the risk of death (HR=0.37, 95% CI: 0.21-0.65, P=0.0003). The 3-year survival rate was also higher in the transplant group (65.5% vs. 38.9%).

The estimated restricted mean survival time (RMST) at 60 months was 43.9 months in the transplant group compared to 31.3 months in the chemotherapy group, extending survival by 12.6 months for the transplant group.

Among patients adhering to the treatment protocol, more than half of the transplant group remained alive, with the median survival not yet reached, compared to 26.6 months in the chemotherapy group. The 5-year survival rate was significantly higher in the transplant group (73.2% vs. 9.3%). The median progression-free survival was 17.4 months in the transplant group versus 6.4 months in the chemotherapy group, with a 3-year progression-free survival rate of 32.9% versus 3.9%. The 5-year progression-free survival rate was also higher in the transplant group (19.9% vs. 0%), with a 66% reduction in the risk of disease progression (HR=0.34, 95% CI: 0.20-0.57, P<0.0001).

Recurrence and Safety

Among the 36 patients in the transplant group, 26 experienced isolated recurrences, and 73% (19/26) of them received chemotherapy, while 46% (12/26) underwent surgery or local ablation. No patients in the transplant group received best supportive care during their first recurrence.

Regarding safety, three patients in the transplant group underwent re-transplantation due to primary graft failure, and one patient died postoperatively from multiple organ failure. The most common severe complications were biliary and pulmonary issues, as well as early graft dysfunction. Grade 3 or 4 toxicity was observed in 36% (8/22) of patients in the transplant group after transplantation and chemotherapy, compared to 47% (17/36) in the chemotherapy-only group.

Conclusion

This study indicates that for patients with unresectable colorectal cancer liver metastasis, the combination of liver transplantation and chemotherapy significantly improves survival compared to chemotherapy alone, offering a promising new treatment option.

73% of Patients Survive Beyond 5 Years: A New Treatment Option for Colorectal Cancer

Reference:

[1] trialAdam, RenéAdam, René et al.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.The Lancet, Volume 404, Issue 10458, 1107 – 1118

(source:internet, reference only)

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