When Amy Piccioli goes to the emergency room for dehydration, she doesn’t expect to hear the words that will turn her life upside down. At only 39 years old, this mother of three children learned that she was suffering from colorectal cancer that had already spread to her liver. A stage 4 as they say. Without any particular symptoms or family history, the diagnosis is brutal.
Conventional treatments insufficient at this stage
Without waiting, Amy quickly began several cycles of chemotherapy, then immunotherapy. These classic therapeutic options sometimes make it possible to slow down the progression, but rarely to cure. But despite these heavy treatments, doctors remain cautious: when liver metastases are numerous or unresectable, the chances of long-term survival remain low.
In his case, the liver metastases were too numerous to be surgically removed. It is then that a still rare avenue emerges: liver transplantation.
A medical… and human gesture
For Amy, the announcement doubles as an extraordinary gesture of solidarity. A close friend discovers she is compatible, and agrees to donate part of her liver. Thanks to the exceptional capacity of this organ to regenerate, both the donor and the recipient can regain normal liver function after the procedure.
Three months after the operation, the examinations were clear: no more detectable traces of cancer. Amy is gradually returning to a normal life, under immunosuppressive treatment and with regular medical monitoring. But without stage 4 cancer. If this can give rise to strong hope, how is this even possible?
Why liver transplant can “erase” cancer
The answer would come from the “localization” of the cells. In some advanced colorectal cancers, metastases are mainly concentrated in the liver. “The liver is the major site of dissemination of these cancers, affected in approximately one in two cases. explains Dr. Gérald Kierzek.
The transplant then radically changes the strategy. “An orthotopic liver transplant consists of completely replacing the diseased liver with a healthy organ. If all the secondary lesions are confined to the liver, we can thus eliminate the entire visible tumor volume in a single intervention”specifies the doctor.
Long considered unthinkable in metastatic oncology, this approach is now attracting growing interest. Recent trials, such as the TransMet study carried out in particular at the Paul-Brousse hospital (AP-HP), have shown spectacular results: five-year survival of up to 73% with transplantation combined with chemotherapy, compared to around 9% with chemotherapy alone. Nearly half of the patients were in complete remission after several years of follow-up.
“It’s a real conceptual revolutionemphasizes Dr. Kierzek. Metastatic disease was not previously considered curable. In very well selected patients, transplantation now opens up the prospect of cure.”;
A promising option but not for everyone
Despite these successes, specialists call for caution.
“Transplantation only concerns a limited number of patients”recalls Dr. Gérald Kierzek. The selection is strict:
- Metastases mainly limited to the liver (and sometimes to the lungs);
- Good response to chemotherapy for at least three months;
- Good general condition and age generally less than 65 years;
- Absence of rapid recurrence after treatments.
Other constraints exist. The immunosuppression required for life exposes people to risks of infections, rejection and secondary cancers. The shortage of grafts also limits access to this strategy.
Finally, the transplant is not synonymous with certain cure.
“The main limitation remains the possible presence of invisible cancer cells elsewhere in the body. They can reawaken secondarily. We therefore speak of remission, not always of definitive cure”insists the doctor.
But in practice, when possible, so-called “resective” surgery, consisting of removing metastases while preserving the liver, remains the standard treatment, with five-year survival rates of 40 to 50%.
Towards new perspectives
The strategy therefore presents a certain interest but also a lot of hope. Several clinical trials are currently underway, particularly in France, to better define the indications for transplantation in metastatic colorectal cancers and potentially broaden access to this option.
For Amy, more than a medical advance, this choice represents above all a rebirth. “This ordeal changed my outlook on life. I tell myself today that I still have time to do the important things”she confides. A second chance which, for some patients, was still only a hope a few years ago.