liver transplants for patients with unresectable liver mets

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juliej
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liver transplants for patients with unresectable liver mets

Postby juliej » Wed Mar 05, 2014 4:55 pm

We've talked about this before: why not give liver transplants to patients with unresectable liver mets? Well, there was an Interesting presentation at the 2014 ASCO Annual Meeting: "Outcome after liver transplantation compared with chemotherapy in colorectal cancer patients with nonresectable liver-only disease."

Liver transplantation? Yes, that's what they said. It was a small study, but patients who received only first-line chemotherapy at the time of the transplant had a 5 year OS of 80%! :D

Here's their conclusion. (Note: CLM means "colorectal liver metastases" and Ltx means "liver transplant.")
Patients with non-resectable CLM only, has a dramatic improved OS after Ltx compared to chemotherapy. The difference could not be explained by patient selection. Selected patients with CRC obtain OS similar to Ltx patients transplanted for primary liver malignancies. Selected CRC patients should therefore be considered for Ltx. Clinical trial information: NCT01311453.

Here is a link to the study: http://meetinglibrary.asco.org/content/123113-143

Here is a link to the Phase 3 clinical trial in Norway, which is currently recruiting patients: http://clinicaltrials.gov/show/NCT01311453
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

KWT
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Joined: Thu Jul 11, 2013 7:22 pm

Re: liver transplants for patients with unresectable liver m

Postby KWT » Wed Mar 05, 2014 7:06 pm

that seems like a no brainer,What about lungs do they do lung transplants?

Maybe only if yer dick cheney

Ratepo
Posts: 71
Joined: Thu Oct 10, 2013 1:56 am

Re: liver transplants for patients with unresectable liver m

Postby Ratepo » Thu Mar 06, 2014 3:52 am

I have to say I'm very, very wondered about these outcomes! We've discussed this with surgeons but they said it was a no go. Main reasons being that the cancer is likely to spread to other organs and because of the transplant the immune system has to be surpressed so the liver won't be rejected (or something like that..) so the disease can also return in the new liver.

There is a shortage of donors, but living donors can also be used. If I can give my father a couple extra years I'd be happy to have a part of my liver transplanted. I know however it's not that simple.

Here is also something worth reading about it (all recent reports, some related to each other):

Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases: A Paradigm Change? http://journals.lww.com/annalsofsurgery/Citation/publishahead/Liver_Transplantation_for_Unresectable_Colorectal.98068.aspx
Patterns of recurrence after liver transplantation for nonresectable liver metastases from colorectal cancer. http://www.ncbi.nlm.nih.gov/pubmed/24370906
The Pub Med report about the study Juliej discusses: Liver transplantation for nonresectable liver metastases from colorectal cancer http://www.ncbi.nlm.nih.gov/pubmed/23360920
Liver transplantation in a patient with unresectable colorectal liver metastases -- a case report. http://www.ncbi.nlm.nih.gov/pubmed/24157119
Liver transplantation for neuroendocrine tumors in Europe-results and trends in patient selection: a 213-case European liver transplant registry study. http://www.ncbi.nlm.nih.gov/pubmed/23532105
Liver Transplantation for Unresectable Metastases to the Liver: A New Era in Transplantation or a Time for Caution? http://www.medscape.com/viewarticle/802908 This is a response to previous mentioned studies and argues results are not that impressive.
Father dx 10/12 rectal 4a
11/12 3 liver mets resected
01/13 colostomy
07/13 scan: 1 liver met, op. failed: multiple discovered, start xelox
12/13 mets shrink (kras mut.)
01/14 liver op new hospital: 2 mets removed others disappeared
05/14 & 09/14 NED
01/15 CEA rise to 5
05/15 local reccurence - rad + Xeloda
10/15 op. failed unremovable mets lower pelvis

raeanne-ME
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Joined: Mon Oct 21, 2013 3:19 pm

Re: liver transplants for patients with unresectable liver m

Postby raeanne-ME » Thu Mar 06, 2014 9:57 am

I have been thinking about this all week, and now the topic comes up here! How wonderful!

I read the Norway study and am hopeful. Why can't I give my father part of my liver?? If it gives him an extra 5 (or 10??!) years, so he can see his grandchildren grow, have a better QOL, and maybe even enjoy a glass of scotch again ;) then I will gladly go under the knife. I'll be following this thread and the studies posted.

I really wonder if a US doc would try this for us?!

warm thoughts and healing vibes to all.
Dad (56) diagnosed 10/2013 Stage IV
11/2013-4/2013 xel, rad, folfox
4/30-complications from surgery
Danced at his daughter's wedding 8/9/14
More chemo and kicking butt.

Moon
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Joined: Fri Apr 20, 2012 9:42 am

Re: liver transplants for patients with unresectable liver m

Postby Moon » Thu Mar 06, 2014 2:02 pm

This is not a small study, this is a very, very, very small study. The results aren't statistically significant.

The clinical trial you mention will show the same good results because of, the patients are very selectet fx N0, negativ PET scan.

Sorry this will maybe only be an option for a few patient. Where will you get the livers from?







Don't trust a study, you didn't fake yourself
nov. 2011 RC Stage 3
dec. 2011 lap. rectumresection, temp. ileo.
jan.-june 2012 FLOX
aug. 2012 ileo. rev.
jan, sept 2013 surg. for livermet
june 2014 local recurrence + PC, FOFIRI/Avastin june-dec. break
june 2015 surg. for colon blockage

pukalania
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Location: Honolulu, Seattle

Re: liver transplants for patients with unresectable liver m

Postby pukalania » Thu Mar 06, 2014 2:40 pm

Has anyone on this board done a liver transplant? When discussed with 2 liver surgeons, one a liver transplant surgeon they said since the immune system gets suppressed before the transplant the cancer may pop up in other organs and it will carries greater risks than not having a liver transplant...

Thank you for posting this, and all the studies, hopefully there is a good answer!
wife 34 dx DH stage IV
Feb10 col res
May10 12 x FOLFOX
Aug12 tumor in sig colon,mets in liver
Aug12 Xeliri Ava
Oct12 xel celebrx rad
Feb13 liver/colon res
Sep13 ill reversal, fistula,
Folfiri SBRT,ADAPT ava
Apr 15 continued growth liver and lungs

dxycn
Posts: 9
Joined: Thu Oct 09, 2014 10:07 am

Re: liver transplants for patients with unresectable liver m

Postby dxycn » Fri Oct 24, 2014 11:33 am

there is a new post http://www.ncbi.nlm.nih.gov/pubmed/25297902

seems very promising

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BrownBagger
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Location: Central NYS

Re: liver transplants for patients with unresectable liver m

Postby BrownBagger » Fri Oct 24, 2014 11:55 am

I used to think, "Heck, I've got a perfectly good liver. When I die, why not give it to some other CRC patient? Or better yet, have them donate their lungs to me?"

But, as has been pointed out, suppressing the immune system for a successful transplant would only give the cancer (who knows where it's lurking?) more opportunity to grow elsewhere.

Once you get a Stage 4dx, lots of things suddenly go off limits. I think the option of getting transplants is one of them.

But I agree with Kenny about Dick Cheney.
Eric, 58
Dx: 3/09, Stage 4 RC
Recurrences: (ongoing, lung, bronchial cavity, ribs)
Major Ops: 6/ RFA: 3 /bronchoscopies: 8
Pelvic radiation: 5 wks. Bronchial radiation—brachytheray: 3 treatments
Chemo Rounds (career):136
Current Chemo Cocktail: Xeloda & Erbitux & Irinotecan biweekly
Current Cocktail; On the Wagon (mostly)
Bicycle miles post-dx 10,477
Motto: Live your life like it's going to be a long one, because it just might, and then you'll be glad you did.

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NZJay
Posts: 640
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Location: NZ

Re: liver transplants for patients with unresectable liver m

Postby NZJay » Fri Oct 24, 2014 1:34 pm

Somewhat relevant: after my first oxi infusion I went into kidney failure. I really didn't want to stop taking it and asked why not just fry my kidneys and give me a new one. They said cancer patients aren't eligible for organ transplant as the "binding" drugs cause cancer to grow. So they dumped the oxi :(
11-13 Dx CC
SPS T4b(touched stomach organ),N1(3/23),M0(Stage 3B)
11-13: resect + partial gastrect
2-14: 1 Tx Cape + Oxy; renal failure, colitis
4-14: 7 Tx Capecitabine
1-15: clear CT
7-15: clear scope
1-16: clear CT
3-17: clear CT
10-17: clear scope (5 year gap now!)
CEA@dx: 8.4 / 6-15: 4.0 / 10-15: 4.2 / 2-16: 4.9 / 7-16: 4.9 / 11-16: 5.0 / 6-17: 4.5
NED since resection

dxycn
Posts: 9
Joined: Thu Oct 09, 2014 10:07 am

Re: liver transplants for patients with unresectable liver m

Postby dxycn » Sat Oct 25, 2014 2:10 am

look at this

http://link.springer.com/article/10.124 ... ltext.html

In addition, in our study, pulmonary metastases were present at the time of Lt, or even before Lt in seven patients. Our initial fear was accelerated growth of overlooked metastases when patients were given the continuous immunosuppressive medication . However, six of the seven patients who actually had pulmonary metastases at the time of Lt were among those who have survived longest in the study. This pilot study cannot give possible explanations for the slow growth rate of pulmonary metastases. One can speculate whether the antineoplastic properties of mammalian target of rapamycin inhibitors or the removal of hepatic tumor load which would otherwise have killed the patients and thus set the stage for more slowly growing pulmonary metastases contributed to this phenomenon. The standard chemotherapy given before Lt may have suppressed the growth of manifest pulmonary metastases preoperatively.Thus, the short disease-free survival caused by increased growth of lung metastases might be a consequence of termination of chemotherapy at Lt. Nevertheless, a 5-year OS of 60 % demonstrates that the immunosuppressive treatment used in the study did not induce accelerated growth of pulmonary malignancy.


the pilot shows that the immunosuppressive treatment used in the study did not induce accelerated growth of pulmonary malignancy.

most of the pulmonary metastases were slow growing, and several were accessible to surgery.


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