Liver-directed therapies for colorectal liver metastases

Colorectal cancer is the third most common cancer diagnosed in the United States, with an anticipated 53,000 deaths from this disease in 2025. Greater than one in five patients will present with synchronous colorectal liver metastases (CRLMs), and 25%-30% will develop CRLMs during the course of the disease. In addition, the rate of liver-specific recurrence is high, with recurrences in 50%-75% of patients who previously underwent resection for liver metastasis. Surgical resection remains the cornerstone of treatment for resectable CRLM, but a significant proportion of CRLMs are unresectable on presentation. Unique treatment strategies have been developed to expand treatment options and improve outcomes. Today, there are multiple established therapies in routine practice as well as novel therapies that are currently under development with promising results to date. Each therapy has its own goals ranging from reducing the chances of locoregional recurrence, supporting an effort to convert unresectable disease burden into potentially resectable tumors, and salvage options with the goal of extending survival. Because most liver-directed therapies are complementary, it is also important to understand how each option affects other therapies to develop a coordinated treatment strategy. Specifically, it is essential to understand the indications, limitations, and outcomes of each option when making multidisciplinary treatment decisions. In this article, the authors review the current landscape of liver-directed therapies and briefly discuss promising emerging treatment options.