Objective: To assess the proportion of unresectable colorectal liver metastasis (CRLM) patients meeting liver transplant (LT) criteria and define their outcomes following hepatic artery infusion pump (HAIP) chemotherapy. Summary Background Data: The TransMet RCT demonstrates improved survival with combined LT and systemic versus systemic therapy alone; however, systemic therapy might not be the best control. This study assesses outcomes in similarly selected patients treated with HAIP. Methods: We identified unresectable CRLM patients treated with HAIP between 2006-2016. Modified TransMet/SECA-II selection criteria were applied, including pre-treatment with at least 1 st line chemotherapy before HAIP placement. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan-Meier methods from HAIP placement. Results: Of 483 patients identified, 23 (4.8%) were LT-eligible. Median age was 52 years (range:37,73). Primary tumors were right-sided in 6 (23%) and rectal in 12 (52%). Eight (38%) patients were KRAS mut . Median CRLM size and number were 28 mm (range:9,92) and 11 (range:4,38). Median pre-HAIP chemotherapy cycles were 8 (range:3,20), and most patients were on 1 st (15,65%) or 2 nd (7,30%) line therapy. Conversion to resection occurred in 18 (78%) patients after a median of 5 (range:1,20) HAIP chemotherapy cycles. With a median follow-up time of 98 (95%CI:96,NR) months, median OS was 61 (95%CI:36,92) months, and 5-year OS was 53% (95%CI:36,79). Median PFS was 13 (95%CI:10,22) months. Conclusions: In this cohort, less than 5% of unresectable CRLM patients were LT-eligible. After treatment with HAIP chemotherapy, overall 5-year survival was 53%, similar to a recent LT randomized trial (5-year OS 57%).
Chandra et al. (Tue,) studied this question.