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Surgeons at Toronto General Hospital have begun a research study to determine if living donor liver transplantation is an effective treatment for colorectal cancer which has spread to the liver.
The first patient in this study, who has chosen to remain anonymous, underwent chemotherapy treatment, followed by a living donor liver transplant. Both the donor and recipient are doing well two months after transplantation.
The innovative study hopes to recruit about 20 patients with colorectal cancer which has spread to the liver, who are being treated with chemotherapy. Their cancer must be stable, and not growing, and they cannot be candidates for liver cancer surgery. Patients must have someone willing to be a living liver donor.
They will also be chosen according to specific cancer criteria, so that the cancers are less likely to recur.
The study is still recruiting patients.
After transplantation, patients will be followed for five years to test longevity, to see if they remain cancer-free, and to determine best treatments should the cancer reoccur.
Colorectal cancer is the second most commonly diagnosed cancer in Canada and the second leading cause of cancer death. On average, about 70 Canadians are diagnosed with this cancer every day.
Cancer spread to the liver occurs in about half of all patients. Although surgical removal of the liver cancer is possible, only 20 per cent to 40 per cent of patients are candidates for this surgery. For those who can't undergo surgery, palliative chemotherapy is the only option, with a survival rate of less than 10 per cent to 20 per cent at five years.
UHN transplant surgeon Dr. Gonzalo Sapisochin and his team of UHN co-investigators and collaborators, want to test another potential treatment option for colorectal cancer patients whose cancer has spread to the liver: liver transplantation.
UHN study will use donated livers from living donors
In their surgical experience with UHN patients whose colorectal cancer has spread to the liver, the team observed that surgical removal of the cancer in the liver offered a distinct survival advantage for these patients. They found a five-year survival rate of 47 per cent and a 10-year survival rate of 28 per cent after surgical removal of tumours in the liver.
The team then reasoned that in those patients whose primary cancer has been removed, and whose secondary liver cancer could not be surgically removed, the whole diseased liver could be replaced with a new donor organ by transplantation.
Dr. Sapisochin explains that advances in transplant surgical techniques, imaging, chemotherapy, standardized patient selection and post-operative care have all combined to "push the envelope of what treatments we can offer patients with cancer which is confined to the liver."
He calls this approach a new era of transplant oncology.
Dr. Sapisochin also points to a 2018 study from Norway which shows that liver transplantation as a treatment for colorectal cancer which has spread to the liver achieved an overall survival rate of 60 per cent at five years – far better than what current palliative chemotherapy can offer patients.
The Norway study used livers from deceased donors, while the UHN study is using donated livers from living donors.
With living donation, it's possible to plan for the date of surgery and make sure that chemotherapy treatment is completed immediately before transplantation, says Dr. Sapisochin.
"We think that pre-transplant chemotherapy, careful monitoring of tumours, and living donation will give our patients better results," he says.
The study aims to publish its first outcomes in 2020.