ASCO Salt Lake City: Dr Gilcrease Discusses the TransMet Trial
Presented by:
G. Weldon Gilcrease III, MD, Huntsman Cancer Center and University of Utah
Meeting:
Total Health ASCO Direct™ Salt Lake City
The Bottom Line
Patients with colorectal cancer that is not amenable to surgery, and which has spread beyond the primary site (metastatic disease) have generally poor five year survival outcomes with chemotherapy. A new study suggests that, if their metastatic disease is confined to the liver, some of these patients might benefit from a liver transplant, which can improve their survival over chemotherapy alone.
Background:
The 5-year survival of colorectal cancer (CRC) patients with who have spread of their cancer beyond the primary site (metastasis) and whose disease is not amenable to surgery (unresectable) is typically between 5 and 10%. Previous findings had shown that a liver transplant (LTx) can improve the survival of CRC patients with unresectable, metastatic disease that is limited to the liver only to 50% or greater at 5 years. The TransMet trial was therefore designed to evaluate the impact of chemotherapy alone, or LTx with chemotherapy on 5 year survival for patients with liver only metastases and no local recurrence of their CRC.
Trial Design and Patients:
The trial randomized patients with unresectable colorectal cancer metastases in the liver (N=94) to chemotherapy alone (n=47) or to liver transplantation (LTx) with chemotherapy (n=47). Patients in the trial were aged 47 through 59 years, with liver-only unresectable disease, and had a median of 20 liver metastases. Patients in the trial were also required to have CRC that was wild-type (non-mutant) for a gene called BRAF V600E.
Main Trial Results:
A total of 38 patients (81%) who were randomized to the LTx arm were able to be transplanted, and the remaining 19% had progression while waiting for LTx. Three patients randomized to LTx (8%) underwent re-transplantation. For those patients that made it to LTx, the 5 year survival was 73% as compared to 9% in the chemotherapy alone group. Similarly, in the intent to treat population (which takes into account the dropout of patients who did not make it to transplant), the 5 year survival was 57% versus 13% in the LTx and chemotherapy alone groups.
Conclusions and Faculty Insights:
Commenting on the overall results from TransMet, Dr Gilcrease noted the survival difference with LTx relative to chemotherapy alone was “just unheard of in this setting”. He further noted that with improvements in transplantation technology and an increasing number of living liver donors, a greater number of livers will be available for transplant than in years past. Dr Gilcrease noted that while further research needs to be done to determine which patients are the best suited for a transplant, LTx may be an option for a limited number of carefully selected CRC patients with unresectable, liver only metastatic disease.
““Essentially… seventy three percent versus nine percent is probably what everybody’s going to be talking about… I think that’s really quite remarkable” ”
Speaker Disclosure Information:
Dr Gilcrease reported no relevant disclosures for this presentation.