Advertisement

Annals of Surgical Oncology

, Volume 22, Issue 7, pp 2195–2200 | Cite as

Is Liver Transplantation an Option in Colorectal Cancer Patients with Nonresectable Liver Metastases and Progression on All Lines of Standard Chemotherapy?

  • Svein DuelandEmail author
  • Morten Hagness
  • Pål-Dag Line
  • Tormod Kyrre Guren
  • Kjell Magne Tveit
  • Aksel Foss
Colorectal Cancer

Abstract

Background

About 50 % of patients with metastatic colorectal cancer (CRC) will develop metastatic disease with liver as primary metastatic site. The majority of CRC patients has nonresectable disease and receives palliative chemotherapy. Overall survival (OS) from time of progression on last line of chemotherapy in metastatic CRC is about 5 months. CLM have been considered a contraindication for liver transplantation. However, we have previously reported 5-year OS of 60 % after liver transplantation for nonresectable CLM. There were six patients who had progressive disease (PD) on last line of standard chemotherapy at the time of liver transplantation; here we report the outcome for these six patients.

Methods

Patients with nonresectable liver-only CLM received liver transplantation in the SECA study, a subgroup of six patients whose disease had progressed on all standard lines of chemotherapy.

Results

These patients with nonresectable disease and PD on the last line of standard chemotherapy at time of liver transplantation had 8–35 metastatic lesions in the liver with the largest diameter at 2.8–13.0 cm. All patients had a relapse within 2.1–12.4 months after liver transplantation. Some patients received treatment with curative intent at the time of relapse, and median OS after transplantation was 41 months with a Kaplan–Meier calculated 5-year OS of 44 %.

Conclusions

Liver transplantation in nonresectable CLM patients with extensive tumor load and PD on the last line of chemotherapy had extended OS compared with any other treatment option reported in the literature.

Keywords

Overall Survival Liver Transplantation Progressive Disease Median Overall Survival Palliative Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work was supported by South-Eastern Norway Regional Health Authority, Oslo University Hospital, and Norwegian Cancer Society.

Disclosure

Svein Dueland, Morten Hagness, Pål-Dag Line, Tormod Kyrre Guren, Kjell Magne Tveit, Aksel Foss has no conflict of interest.

References

  1. 1.
    Kanas GP, Taylor A, Primrose JN, Langeberg WJ, Kelsh MA, Mowat FS, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol. 2012;4:283–301.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Masi G, Vasile E, Loupakis F, Cupini S, Fornaro L, Baldi G, et al. Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis. J Natl Cancer Inst. 2011;103:21–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med. 2009;360:1408–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Glimelius B, Cavalli-Bjorkman N. Metastatic colorectal cancer: current treatment and future options for improved survival. Medical approach—present status. Scand J Gastroenterol. 2012;47:296–314.PubMedCrossRefGoogle Scholar
  5. 5.
    Van Cutsem E, Kohne CH, Lang I, Folprecht G, Nowacki MP, Cascinu S, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol. 2011;29:2011–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, et al. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol. 2010;28:4697–705.PubMedCrossRefGoogle Scholar
  7. 7.
    Tveit KM, Guren T, Glimelius B, Pfeiffer P, Sorbye H, Pyrhonen S, et al. Phase III trial of cetuximab with continuous or intermittent fluorouracil, leucovorin, and oxaliplatin (Nordic FLOX) versus FLOX alone in first-line treatment of metastatic colorectal cancer: the NORDIC-VII study. J Clin Oncol. 2012;30:1755–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Sobrero AF, Maurel J, Fehrenbacher L, Scheithauer W, Abubakr YA, Lutz MP, et al. EPIC: phase III trial of cetuximab plus irinotecan after fluoropyrimidine and oxaliplatin failure in patients with metastatic colorectal cancer. J Clin Oncol. 2008;26:2311–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP, Alberts SR, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol. 2007;25:1539–44.PubMedCrossRefGoogle Scholar
  10. 10.
    Peeters M, Price TJ, Cervantes A, Sobrero AF, Ducreux M, Hotko Y, et al. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol. 2010;28:4706–13.PubMedCrossRefGoogle Scholar
  11. 11.
    Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2013;381:303–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, et al. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transpl. 2011;17(Suppl 2):S44–S57.PubMedCrossRefGoogle Scholar
  13. 13.
    Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13:e11–e22.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    McCashland T, Watt K, Lyden E, Adams L, Charlton M, Smith AD, et al. Retransplantation for hepatitis C: results of a U.S. multicenter retransplant study. Liver Transpl. 2007;13:1246–53.PubMedCrossRefGoogle Scholar
  15. 15.
    Hagness M, Foss A, Line PD, Scholz T, Jorgensen PF, Fosby B, et al. Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg. 2013;257:800–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Dueland S, Guren TK, Hagness M, Glimelius B, Line PD, Pfeiffer P, et al. Chemotherapy or liver transplantation for non-resectable liver metastases from colorectal cancer? Ann Surg. Google Scholar
  17. 17.
    Adam R, Pascal G, Castaing D, Azoulay D, Delvart V, Paule B, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Suzuki C, Blomqvist L, Sundin A, Jacobsson H, Bystrom P, Berglund A, et al. The initial change in tumor size predicts response and survival in patients with metastatic colorectal cancer treated with combination chemotherapy. Ann Oncol. 2012;23:948–54.PubMedCrossRefGoogle Scholar
  19. 19.
    Cercek A, Aguilo A, Gluskin J, Chou JF, Reidy DL, Saltz L, et al. Response rates to hepatic arterial infusion (HAI) pump therapy in patients with metastatic colorectal cancer liver metastases (mCRC LM) after progression on all standard chemotherapies. Poster at ASCO GI, 2014. J Clin Oncol. 2014;32 (suppl 3); abstr 597.Google Scholar
  20. 20.
    Seidensticker R, Denecke T, Kraus P, Seidensticker M, Mohnike K, Fahlke J, et al. Matched-pair comparison of radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver-dominant colorectal metastases. Cardiovasc Intervent Radiol. 2012;35:1066–73.CrossRefGoogle Scholar
  21. 21.
    Karapetis CS, Padman SJ, Beeke C, Padbury R, Kitchener M, Kirkwood I, et al. The management of colorectal cancer (CRC) liver metastases with yttrium-90 microspheres (Y90): the south Australian (SA) experience. Poster at ASCO GI, 2014. J Clin Oncol. 2014;32 (suppl 3); abstr 666.Google Scholar
  22. 22.
    Hagness M, Foss A, Egge TS, Dueland S. Patterns of recurrence after liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg Oncol. 2014;21:1323–9.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Martins PN, Movahedi B, Bozorgzadeh A. Liver transplantation for unresectable colorectal cancer liver metastases: a paradigm change? Ann Surg. 2014.Google Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Svein Dueland
    • 1
    Email author
  • Morten Hagness
    • 2
    • 3
  • Pål-Dag Line
    • 2
  • Tormod Kyrre Guren
    • 1
    • 4
  • Kjell Magne Tveit
    • 1
    • 3
    • 4
  • Aksel Foss
    • 2
    • 3
  1. 1.Department of OncologyOslo University HospitalOsloNorway
  2. 2.Section for Transplantation Surgery, Department of Transplantation MedicineOslo University HospitalOsloNorway
  3. 3.Institute of Clinical MedicineUniversity of OsloOsloNorway
  4. 4.K.G.Jebsen Colorectal Cancer Research CenterOslo University HospitalOsloNorway

Personalised recommendations