Neoadjuvant Chemo for Intrahepatic Cholangiocarcinoma May Prolong Life

By Reuters Staff

March 12, 2021

NEW YORK (Reuters Health) - For patients with intrahepatic cholangiocarcinoma (ICC), the benefits of neoadjuvant chemotherapy (NAC) may extend beyond downstaging borderline resectable disease to improved overall survival, according to a small retrospective study.

The incidence of ICC in the United States is increasing, likely due to an increase in known risk factors for ICC, most notably population-level increases in nonalcoholic fatty liver disease (NAFLD), Dr. Thomas Sutton and colleagues with Oregon Heath and Science University, in Portland, note in the American Journal of Surgery.

NAC has recently emerged as a promising way to identify patients with poor prognosis, "possibly obviating a morbid and nontherapeutic resection, as well as for potentially downstaging initially unresectable patients," they point out. However, the role of NAC in ICC beyond unresectable patients is unclear.

Dr. Sutton and colleagues evaluated the association of NAC with perioperative and oncologic outcomes in ICC in 52 patients (median age, 64) with ICC who underwent liver resection from 2004 to 2017 at their center.

Ten patients (19%) received NAC for a median of 14 weeks, most commonly with gemcitabine-cisplatin.

Three-year recurrence-free survival was 46% with NAC and 25% with upfront surgery (P=0.571) and five-year overall survival was 80% and 37% (P=0.096), respectively.

In multivariate analysis controlling for AJCC stage and margin status, receipt of NAC was independently associated with improved five-year overall survival (hazard ratio, 0.16; 95% confidence interval, 0.04 to 0.66), but not three-year recurrence-free survival (HR, 0.54; 95% CI, 0.18 to 1.62).

NAC was not associated with major postoperative complications or R1 margins.

"NAC in ICC may hold oncologic benefits beyond downstaging borderline resectable disease, such as identifying patients with favorable biology who are more likely to benefit from resection," Dr. Sutton and colleagues write.

"Non-progression during neoadjuvant chemotherapy for intrahepatic cholangiocarcinoma may signify more indolent disease biology that is more likely to benefit from curative-intent resection," they add.

The authors caution that their results represent a single-center, retrospective experience over 13 years with a limited number of patients. They urge "additional study of this treatment philosophy in patients with potentially resectable ICC in the form of prospective randomized trials, particularly for those with high-risk features identified preoperatively."

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: American Journal of Surgery, online March 1, 2021.