Convergent systemic therapy for liver metastases: Bridging primary tumor heterogeneity through shared pathways

Abstract

Liver metastases represent a major clinical challenge in oncology, often indicating advanced disease with complex management requirements. Despite originating from diverse primary tumors such as colorectal, pancreatic, and breast cancers, liver metastases exhibit shared biological behaviors influenced by the unique tumor microenvironment and immunosuppressive conditions of the liver. This review synthesizes advances in systemic, locoregional, and surgical therapies, demonstrating how shared mechanisms enable unified strategies such as pathway-targeted agents and immunotherapy–radiotherapy combinations, even amid primary tumor heterogeneity. Multidisciplinary team collaboration is critical for optimizing individualized treatment plans, balancing locoregional and systemic treatments to convert unresectable cases and improve the survival rate. We propose a paradigm of precision convergence “harmonizing tumor therapies with lineage-specific adjustments” guided by the principle of “commonalities in biology, divergences in context”.