LIQUID BIOPSY IN LIVER TRANSPLANTATION FOR COLORECTAL CANCER LIVER METASTASIS: DESCRIPTION OF A SMALL CASE SERIES
Roma Raj*1, Chase J. Wehrle1, Nihal Aykun1, Danny Orabi1, Bassam Estfan2, Suneel Kamath2, Smitha Krishnamurthi2, Masato Fujiki1, Koji Hashimoto1, Cristiano Quintini1, Choon Hyuck David Kwon1, Teresa Diago Uso1, Kazunari Sasaki3, Federico Aucejo1
1DDSI, Cleveland Clinic, Cleveland, OH; 2Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH; 3Department of Surgery, Stanford University, Stanford, CA
Introduction:
Colorectal cancer is a leading cause of cancer-related death worldwide. Metastatic liver disease develops in 50% of cases and drives patient outcomes. Although the ideal treatment for colorectal cancer liver metastases (CRLM) is resection, only a third of patients are suitable for this approach. Reports of liver transplantation in selected patients with unresectable CRLM have shown encouraging results compared to conventional forms of therapy. No study to date has examined the utility of liquid biopsy circulating tumor DNA (ctDNA) for evaluation of residual disease in this cohort of patients. We report a small series of liver transplantation in patients with CRLM in whom ctDNA was assessed perioperatively.
Methods:
Six patients underwent liver transplantation for unresectable CRLM or liver failure following CRLM treatment from 2018-2022. Clinical data, cross-sectional imaging and serum biomarkers including perioperative ctDNA were reviewed from electronic medical records.
Results: All patients are alive without radiologic evidence of disease at time of this publication. Median time of follow up was 21 months (range 2-35 months). ctDNA was assessed before (4 patients) and after transplant (5 patients). One patient (patient # 2) experienced a pulmonary recurrence that was resected; the remaining patients have not experienced recurrence. Three patients are without evidence of ctDNA following transplant and one demonstrates persistent ctDNA positivity at 47-months post-transplant. The two patients with positive pre-transplant ctDNA remain ctDNA negative post-transplant. Post transplant ctDNA result from two patients were under process at the time of writing this abstract.
CEA levels were assessed for all six patients before transplant and four showed elevated levels. Only three had post-transplant CEA.
Conclusions:
iver transplantation for liver-confined unresectable CRLM is emerging as a valid surgical option in selected patients. The significance of liquid biopsy in this population remains elusive due to lack of data. This small series indicates that liver transplantation can clear circulating tumor burden in the setting of metastatic disease and despite systemic immunosuppression. The significance and usefulness of liquid biopsy in patient selection, surveillance and as an indication for treatment warrants further investigation.
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