Is Liver Transplantation an Option in Colorectal Cancer Patients with Nonresectable Liver Metastases and Progression on All Lines of Standard Chemotherapy?
- 1.4k Downloads
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.
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.
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 %.
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.
KeywordsOverall Survival Liver Transplantation Progressive Disease Median Overall Survival Palliative Chemotherapy
This work was supported by South-Eastern Norway Regional Health Authority, Oslo University Hospital, and Norwegian Cancer Society.
Svein Dueland, Morten Hagness, Pål-Dag Line, Tormod Kyrre Guren, Kjell Magne Tveit, Aksel Foss has no conflict of interest.
- 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.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.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
- 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.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
- 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
- 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.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.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
- 23.Martins PN, Movahedi B, Bozorgzadeh A. Liver transplantation for unresectable colorectal cancer liver metastases: a paradigm change? Ann Surg. 2014.Google Scholar