At age 46, Doug Vincent received a shock. Not only was he diagnosed with stage four colorectal cancer, but it had also spread to his liver. Six months later, after many rounds of chemotherapy and successfully removing the cancer from his colon, Vincent went under the knife a second time to remove the tumors from his liver.
But the cancer in Vincent’s liver was too extensive to be removed; he needed a liver transplant. Unfortunately, in North America, organs from deceased donors are in short supply and he would have an extremely small chance of receiving one of these organs.
With no other conventional medical options left, Vincent was given one year to live…
… That was nearly three years ago and he is still alive and cancer-free today – thanks to a living-donor liver transplant conducted through an innovative clinical trial at the University of Rochester Medical Center.
Testing a new option for patients in need
Vincent was one of 10 patients treated through a study published in the Journal of the American Medical Association Surgery. This study demonstrates the first successful living-donor liver transplants in North America for patients like Vincent who have liver-confined colorectal cancer tumors which cannot be removed by surgery otherwise.
According to the study, a year and a half after their living-donor liver transplants, all 10 patients were alive and 62 percent remained cancer-free.
“This [study] brings hope for patients who have a dismal chance of surviving a few more months,” said first author of the study, Roberto Hernandez-Alejandro, M.D., who is chief of the Abdominal Transplant and Liver Surgery Division at URMC, which has performed more living donor liver transplants for patients with colorectal liver metastases than any other center in North America. “With this, we’re opening opportunities for patients to live longer – and for some of them to be cured.”
The study, which was conducted across URMC, the University Health Network and Cleveland Clinic, focused on colorectal cancer in part because of its tendency to spread to the liver. Nearly half of all patients with colorectal cancer develop liver metastases within a few years of diagnosis and 70 percent of liver tumors in these patients cannot be removed without removing the entire liver.
Unfortunately, deceased-donor liver transplant is not a viable option for most of these patients because their liver function is fairly normal – despite their tumors. That lands them toward the bottom of the national organ transplant waiting list. In North America, one in six patients dies each year while waiting for an organ on this list.
Thanks to recent advances in cancer treatments, many of these patients are able to get their cancer under systemic control, which means their liver tumors are the only things standing between them and a “cancer-free” label. It also increases the odds that these patients – and their new livers – will remain cancer-free, which is crucial when balancing the benefit to the patient with the risk to a living donor.
“I’ve seen so many cancer patients whose cancer was not spreading, but we couldn’t remove the tumors from their liver and we knew they would die,” said Hernandez-Alejandro, who is also an investigator at the Wilmot Cancer Institute. “We hoped living-donor liver transplant could give them another chance.”
Because it offered a last resort, the study attracted over 90 patients from near and far. Vincent, for example, drove 15 hours from McDonough, GA, to URMC for screening appointments and eventually for his transplant.
All patients and donors went through a rigorous virtual and in-person screening process to ensure they were good candidates for the procedure, and they were educated about the risks of the surgery and the possibility of cancer recurrence.
Vincent says he knew what he was getting into with this study. “We had a lot of thoughts and prayers about it,” he recalls. But he told his wife he was willing to take on the risk as long as the study could help others down the line.
Patients and donors underwent staggered surgeries to fully remove patients’ diseased livers and replace them with half of their donors’ livers. Over time, both patients’ and donors’ livers will regenerate and regain normal function.
Patients have been closely monitored via imaging and blood analysis for any signs of cancer recurrence and will continue to be followed for up to five years after their surgery. At the time the study was published, two patients had follow-ups of two or more years and both remained alive and well, cancer-free.
“This study proves that transplant is an effective treatment to improve quality of life and survival for patients with colorectal cancer that metastasized to the liver,” said senior study author Gonzalo Sapisochin, M.D., a transplant surgeon at the Ajmera Transplant Centre and the Sprott Department of Surgery at the University Health Network.
“As the first successful North American experience, it represents an important step towards moving this protocol from the research arena to standard of care,” adds Sapisochin, who is also a clinician investigator at the Toronto General Hospital Research Institute and an associate professor in the Department of Surgery at the University of Toronto.
As for Vincent, it has been one year and seven months since his transplant and he is still cancer-free. In November, he welcomed his first grandson into the world – something he says he might not have seen if he hadn’t had his transplant.
"This program is phenomenal,” he said. “It saved my life and those doctors are miracle workers. That's what it comes down to."