Does chemoimmunotherapy improve survival for patients with liver metastases?

Liver metastases have been linked to a poorer outlook and may reduce the effectiveness of immunotherapy alone. However, a large analysis of 42 trials involving over 25,000 patients found that combining chemotherapy with immunotherapy (chemoimmunotherapy) improves survival for people with liver metastases just as much as for those without. The survival benefit was consistent across different cancer types and treatment regimens.

What the research says

A 2026 systematic review and meta-analysis of 42 randomized controlled trials with 25,915 patients examined whether liver metastases affect the benefit of adding immunotherapy to chemotherapy ¹⁷. The study found that chemoimmunotherapy significantly improved overall survival (OS) and progression-free survival (PFS) in patients both with and without liver metastases. The interaction hazard ratios were 1.00 for OS and 1.04 for PFS, meaning the treatment effect was not significantly different between the two groups ¹⁷. This suggests that liver metastases do not diminish the survival benefit of chemoimmunotherapy.

However, some research indicates that liver metastases can create an immunosuppressive environment that may hinder immunotherapy response ². A narrative review on colorectal cancer noted that liver metastases develop a tolerogenic niche with immune suppression, which could contribute to resistance to immune checkpoint inhibitors ². Despite this, the large meta-analysis found that chemoimmunotherapy still works well in patients with liver metastases, possibly because the chemotherapy component helps overcome some of this resistance ¹⁷.

For specific cancer types, additional evidence supports these findings. In advanced non-squamous non-small cell lung cancer (ns-NSCLC), a study showed that adding the anti-VEGF drug bevacizumab to chemoimmunotherapy improved outcomes in patients with liver metastases, suggesting that targeting the tumor blood supply can further enhance treatment ⁸. In gastric or gastroesophageal junction cancer, a meta-analysis of randomized trials found that PD-1/PD-L1 inhibitors combined with chemotherapy improved survival, though subgroup analyses by liver metastasis status were limited ⁶.

Other treatments for liver metastases, such as surgical resection or thermal ablation, are also options for some patients, but these are typically considered for localized disease rather than as a replacement for systemic therapy ³⁴⁵.

What to ask your doctor

• Based on my specific cancer type and liver metastasis status, is chemoimmunotherapy a recommended option for me?
• What are the potential benefits and risks of adding immunotherapy to my chemotherapy regimen?
• Are there any additional treatments, such as anti-VEGF therapy, that might improve my response to chemoimmunotherapy?
• How will my liver function be monitored during treatment, and are there any special precautions I should take?
• Are there clinical trials available that are testing new combinations for liver metastases?