Who Should Undergo Transplant for Metastatic Colorectal Cancer?

Fong, Yuman

doi:10.1001/jamasurg.2021.0268

JAMA Surg

2021

DOI: 10.1001/jamasurg.2021.0268

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Who Should Undergo Transplant for Metastatic Colorectal Cancer?

Yuman Fong

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Cited by 2 publications

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“…Dueland et al reported their single-institutional retrospective cohort analysis on LT for CRLM, which was compared with those who received portal vein embolization (PVE) with intent to undergo liver resection (LR). Their results were seemingly encouraging but also misleading; as such, shifting treatment paradigm or making LT a new tool for patients with CRLM still remains a question to be weighed further …”

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confidence: 99%

No Strong Evidence on Liver Transplant for Colorectal Cancer Liver Metastasis Over Portal Vein Embolization Associated With Liver Resection

2022

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experimental arm. However, the proportion of patients with a surgical baseline PCI of 11 to 20 was 14% in both arms (P = .92).Third, Bhatt and colleagues state that 5 patients had no CPM at baseline, probably referring to those with a baseline PCI of 0. Although histologic or cytologic proof of CPM was an eligibility criterion, patients could have a baseline PCI of 0, for example in case of complete excision of a CPM in a referring center without other visible lesions during diagnostic laparoscopy. As these patients had proven CPM, enrolling them seems justified regardless of baseline PCI.Fourth, Bhatt and colleagues question the choice of not evaluating several common first-line systemic regimens, probably referring to triplet chemotherapy or anti-epidermal growth factor receptor therapy. The trial protocol includes a rationale for choosing perioperative doublet chemotherapy and bevacizumab over these therapies. 5 Briefly, we did not choose triplet chemotherapy because of its relatively high toxicity (which may be unacceptable when combined with extensive CRS) and the absence of a necessity of conversion from unresectable to resectable disease. Anti-epidermal growth factor receptor therapy was not chosen because of its unfavorable results when added to perioperative doublet chemotherapy for resectable KRAS wild-type colorectal liver metastases. 6 Fifth, Bhatt and colleagues consider the completion rates of neoadjuvant (76%) and adjuvant treatment (36% after complete CRS) to be low. Importantly, the completion rate of neoadjuvant treatment was similar to that of neoadjuvant doublet chemotherapy for resectable colorectal liver metastases in the new EPOC trial. 6 The completion rate of adjuvant treatment was indeed lower than that of adjuvant treatment for colorectal liver metastases (48%), 6 likely owing to the high morbidity of CRS compared with liver surgery. Altogether, we believe the observed completion rates adequately reflect clinical practice.Lastly, we agree that assessment of pathologic response according to KRAS/BRAF status is interesting. However, oncologic outcomes according to molecular profile will be centrally analyzed after completion of the phase 3 trial. These analyses may identify subgroups that do and do not benefit from perioperative systemic therapy.

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confidence: 99%

No Strong Evidence on Liver Transplant for Colorectal Cancer Liver Metastasis Over Portal Vein Embolization Associated With Liver Resection

2022

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Intentional R1 resection of liver metastases: A new treatment paradigm for patients with advanced colorectal cancer based on a propensity score–Matched case-control analysis

Jenvrin

Galletto-Pregliasco

Audureau

et al. 2023

Clinics and Research in Hepatology and Gastroenterology

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Who Should Undergo Transplant for Metastatic Colorectal Cancer?

Cited by 2 publications

References 6 publications

No Strong Evidence on Liver Transplant for Colorectal Cancer Liver Metastasis Over Portal Vein Embolization Associated With Liver Resection

No Strong Evidence on Liver Transplant for Colorectal Cancer Liver Metastasis Over Portal Vein Embolization Associated With Liver Resection

Intentional R1 resection of liver metastases: A new treatment paradigm for patients with advanced colorectal cancer based on a propensity score–Matched case-control analysis

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