TransMet: Analyzing Liver Transplant Versus Chemotherapy for Colorectal Liver Metastases

At least 25% of patients with colorectal cancer develop colorectal liver metastases (CLM) at some point during their illness. While chemotherapy has been an increasingly effective treatment option for CLM, the 5-year survival rate for these patients is approximately 10%.

As liver transplantation (LT) may be a curative approach for patients with liver-only disease, René Adam, MD, and colleagues developed the TransMet trial to determine the efficacy of chemotherapy with LT compared with chemotherapy alone.

TransMet is the first study to report the safety and feasibility of chemotherapy with LT for patients with unresectable CLM in a large multicenter, randomized, clinical trial.

The primary end point of the study is overall survival. Secondary end points include disease-free survival, progression-free survival, recurrence rates, and quality of life.

Recent outcomes from an interim analysis of the trial included patient eligibility and the feasibility and safety of liver transplantation. Researchers enrolled 94 eligible patients between February 2016 and July 2021, with 47 patients in the chemotherapy with LT arm and 47 in the chemotherapy-only arm.

After a median delay of 51 days to LT after patient randomization in the chemotherapy with LT arm, 38 patients received liver transplants; 9 patients failed to be transplanted because of intercurrent hepatic or extrahepatic progression either before LT or at laparotomy for LT due to unexpected discovery of metastatic lymph nodes at the hepatic hilum or celiac axis. In transplanted patients, 30 underwent transplantation within 2 months after their last cycle of chemotherapy.

All patients continued chemotherapy in the chemotherapy-only arm.

The TransMet trial is ongoing, and upcoming final results are expected to aid in validation of the use of LT in unresectable CLM.