Case Report: Prolonged disease control to FTD/TPI plus bevacizumab and local ablative therapy after early relapse following liver transplantation in metastatic colorectal cancer

Liver transplantation is increasingly considered for highly selected patients with liver-limited disease in metastatic colorectal cancer, although early relapse occurs frequently. In later treatment lines, trifluridine/tipiracil plus bevacizumab is a standard option, but the duration of benefit is generally modest. We describe a 53-year-old male with left-sided, RAS and BRAF wild-type, microsatellite stable metastatic colorectal cancer who developed disseminated recurrence three months after liver transplantation. Subsequent treatment with trifluridine/tipiracil plus bevacizumab led to sustained disease control, including a progression-free interval of 10 months and a total treatment duration of 26 months. During therapy, oligoprogressive lesions were selectively treated with stereotactic radiofrequency ablation while systemic treatment was maintained. Overall survival from treatment initiation reached 34 months, clearly exceeding outcomes reported in the SUNLIGHT trial. This case suggests that clinically meaningful and durable disease control may be achieved with trifluridine/tipiracil plus bevacizumab when combined with a selective strategy addressing oligoprogressive disease, even in the setting of early post-transplant recurrence.