Abstract 50P
Background
Patients with unresectable colorectal liver metastases (CRLM), without extrahepatic disease, receiving palliative therapy have a 5-year overall survival (OS) of 5-8%. In this population, liver transplantation (LT) may be a viable curative option. Recent trials with strict patient selection and chemotherapy regimens have demonstrated excellent outcomes with deceased donor grafts. Living donor LT (LDLT) may be a more favourable option, by circumventing organ shortage and facilitating timely pre-transplant oncologic therapy. This study aims to assess the role of LDLT in treatment of unresectable CRLM.
Methods
Adults with unresectable, liver-only CRLM were recruited in a single-center open-label prospective phase II trial. Patients who had systemic chemotherapy for ≥6 months, with radiologic and biochemical stability on re-staging, and had no evidence of disease on operative portal lymph sampling met candidacy for LDLT. Characteristics and outcomes of transplanted patients in our interim trial analysis are described.
Results
Between October 2016 and April 2024, twelve patients received LDLT (Table). Ten patients received preoperative chemotherapy combined with anti-VEGF (bevacizumab) or anti-EGFR (panitumumab). Four patients additionally received hepatic artery infusion pump (HAIP). All tumors were BRAFV600E wild-type, and two patients had a KRAS mutation. Pre-transplant Oslo score was low (≤2). Median follow-up post-LDLT was 21.1 months (IQR 7.3, 27.9) Two patients died at 39.4 (due to disease recurrence) and 53.7 (unknown cause) months. The recurrence rate was 25%, with one at 12.4 months (abdominal nodes), and two to the lung (3.3 months and 7.3 months). All patients with recurrences received systemic chemotherapy. Table: 50P
Summary of patients that underwent LDLT
| Chemo, # cycles pre-LT | HAIP | RAS mutant | Primary tumour location | Recurrence site, time (months) | Oslo score | Post-LT follow-up (months) | |
| 1 | FOLFIRI/Panitumumab, 25 | N | N | Left | Abdo nodes, 12.4 | 2 | 26.4 |
| 2 | FOLFIRI/Bevacizumab, 60 | Y | Y | Left | N | 1 | 30.9 |
| 3 | FOLFIRINOX/Panitumumab, 21 | Y | N | Left | N | 1 | 26.9 |
| 4 | FOLFIRI/Panitumumab, 20 | N | N | Rectal | N | 0 | 25.5 |
| 5 | FOLFIRI/Bevacizumab, 30 | N | N | Right | Lung, 3.3 | 1 | 39.4 DECEASED |
| 6 | FOLFIRI/Bevacizumab, 32 | Y | N | Left | N | 1 | 53.7 DECEASED |
| 7 | FOLFOX, 32 | N | N | Left | N | 0 | 16.7 |
| 8 | FOLFIRI/ Bevacizumab, 16 | N | N | Rectal | N | 1 | 12.8 |
| 9 | FOLFIRI/Bevacizumab, 29 | N | Left | N | 2 | 7.1 | |
| 10 | FOLFIRI/Panitumumab/Bevacizumab, 54 | N | Y | Left | Lung, 7.3 | 0 | 7.3 |
| 11 | FOLFIRI/Panitumumab, 31 | Y | N | Left | N | 0 | 4.3 |
| 12 | Capecitabine/Irinotecan/Bevacizumab, 30 | N | Left | N | 0 | 0.8 |
Conclusions
The interim analysis of this phase II trial demonstrates encouraging outcomes of LDLT for patients with liver-only CRLM. Further analysis is needed to confirm utility of LDLT in this population.
Clinical trial identification
NCT02864485.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
G. Sapisochin: Financial Interests, Institutional, Research Grant, Grant and for talks, consultancy: Roche; Financial Interests, Institutional, Invited Speaker, consultancy: AstraZeneca, Integra. All other authors have declared no conflicts of interest.