TRANSMET meets OS endpoint

Updated results from the TRANSMET trial revealed that combining chemotherapy with liver transplantation significantly extended survival for patients with colorectal cancer whose liver metastases cannot be surgically removed. The trial demonstrated a 4-fold increase in the 5-year overall survival (OS) rate for patients receiving the combined treatment compared with chemotherapy alone.

Dr Maximiliano Gelli (Gustave Roussy, France) presented the 5-year survival outcomes of the TRANSMET trial (NCT02597348) [1]. TRANSMET investigated the curative potential of chemotherapy followed by liver transplantation versus chemotherapy alone in patients with unresectable colorectal cancer liver metastases (CRCLM) [2].

After a median follow-up of 59 months, 57% of the participants in the combined treatment group survived 5 years versus just 13% in the chemotherapy-only group (HR 0.37; 95% CI 0.21–0.65; P=0.003; see Figure). Despite a high recurrence rate in the combined treatment group, these participants still showed significantly better survival outcomes, pointing to the critical role of liver health in OS.

Figure: Rate of overall survival in the intention-to-treat population of TRANSMET [1]



C, chemotherapy; CI, confidence interval; HR, hazard ratio; LT, liver transplant.

The study's findings suggest a potential shift in the treatment of patients with unresectable CRCLM, though the approach is suitable only for a very select group due to strict eligibility criteria and the limitations of donor organ availability. Dr Gelli also noted the logistical and ethical challenges in expanding liver transplantation criteria for cancer patients, pointing to the need for careful patient selection and resource allocation.

1. Adam R, et al. Chemotherapy and liver transplantation versus chemotherapy alone in patients with definitively unresectable colorectal liver metastases: Updated results from the randomized TRANSMET trial. Abstract 1O, ESMO Gastrointestinal Cancers Congress 2024, 26–29 June, Munich, Germany.
2. Adam R, et al. eClinicalMedicine. 2024:72:102608.

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Posted on 21 August 202421 August 2024