Traditional Chinese Medicine in the Management of Colorectal Cancer Liver Metastasis: Mechanisms, Challenges, and Perspectives

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignancies worldwide, and the liver is its main site of distant metastasis. Colorectal cancer liver metastasis (CRLM) is a major cause of CRC-related death. Current treatments, including surgery, chemotherapy, and immunotherapy, have limited efficacy and often cause substantial side effects. SUMMARY: This review examines the emerging role of traditional Chinese medicine (TCM) in managing CRLM, focusing on its ability to modulate the tumor microenvironment (TME) by inhibiting epithelial-mesenchymal transition, suppressing angiogenesis, and reversing immune evasion. TCM provides a holistic, multi-targeted approach, but most supporting evidence comes from preclinical studies in cell and animal models, with limited clinical validation. KEY MESSAGES: TCM shows promise for targeting the CRLM-related TME. Most evidence is preclinical; well-designed clinical trials are urgently needed. Standardization, pharmacokinetics, and regulatory issues remain major barriers to clinical application.