Treating Liver and Colorectal Metastases: A Comprehensive Overview of Recent Data

During the first session of the 2023 Symposium of Clinical Interventional Oncology (CIO), Nadine Abi-Jaoudeh, MD, University of California Irvine, presented a comprehensive overview of recent study data and innovative treatment approaches for liver and colorectal metastases. 

The session commenced with a discussion of a trial exploring survival outcomes with microwave ablation versus resection for colorectal metastases. The trial included patients with up to 5 colorectal metastases, all less than 3 centimeters in size, eligible for hepatic resection. While the trial was not randomized, propensity score matching was employed to make it as close to randomization as possible. The study found no significant difference in overall survival between the two procedures, although the microwave ablation arm experienced more reinterventions than the resection arm. The microwave approach is being explored in other trials, such as COLLISION, COMET, HELARC, and ACCLAIM, which aim to further evaluate its effectiveness.

Next, Dr Abi-Jaoudeh discussed the use of hepatic perfusion for treating isolated uveal melanoma liver metastases. Patients with uveal melanoma frequently present with isolated liver metastases, leading to a dismal overall survival of around 10 to 12 months. She presented a prospective multicenter randomized controlled trial that evaluated isolated hepatic perfusion with melphalan versus standard of care. The trial showed significantly improved overall response rates, progression-free survival, hepatic progression-free survival, and overall survival with isolated hepatic perfusion. This approach has led to FDA approval for percutaneous hepatic perfusion in uveal melanoma.

The next topic of discussion was the SUNLIGHT study, which focused on treatment of liver and colorectal metastases beyond the second line. Patients who had failed two lines of chemotherapy were enrolled in this trial comparing trifluridine-tipiracil plus avastin to trifluridine-tipiracil alone. The combination treatment showed substantial improvements in overall survival and median progression-free survival. These findings are expected to have a significant impact in establishing trifluridine-tipiracil plus avastin as a third-line treatment option for metastatic colorectal cancer.

Lastly, Dr Abi-Jaoudeh presented a small study from the National Institutes of Health, which combined an oncolytic virus called PEXIVAS with immune checkpoint inhibitors. The small phase 1/2 trial enrolled patients with metastatic colorectal cancer who had failed at least 1 line of chemotherapy. The study results showed no significant difference in progression-free survival between the 2 groups. However, there was a notable infiltration of CD8-positive T cells in the tumors of patients who received combination therapy, which is encouraging for further exploration of this approach.

Throughout her comprehensive look at the year in review for liver metastatic disease, Dr Abi-Jaoudeh highlighted the growing landscape of combination trials and the continuous improvement in oncology drugs. These advancements hold promise for more effective and innovative approaches to treating liver metastases in various cancer types.