Liver Transplantation for Intrahepatic Cholangiocarcinoma: What Are New Insights and What Should We Follow?

Sun, Dawei; Lv, Guoyue; Dong, Jiahong

doi:10.3389/fonc.2021.841694

Cited by 6 publications

(5 citation statements)

References 30 publications

(77 reference statements)

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“…There are considerations to shift the timing of the chemotherapy into the preoperative period as neoadjuvant treatment which could contribute to limiting the toxicities in the post-transplant period. First data on neoadjuvant chemotherapy in patients with intrahepatic cholangiocarcinoma show promising results ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Efficacy of Adjuvant Chemotherapy With Gemcitabine After Liver Transplantation for Perihilar Cholangiocarcinoma - A Multi-Center, Randomized, Controlled Trial (pro-duct001)

Schmelzle

Benzing²,

Fischer³

et al. 2022

Front. Oncol.

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BackgroundLiver transplantation (LT) is considered a therapeutic option for unresectable perihilar cholangiocarcinoma (PHC) within defined criteria. It remains uncertain whether patients can safely receive adjuvant chemotherapy after LT.MethodsWe performed a prospective, multi-center, randomized, non-blinded two-arm trial (pro-duct001). Patients after LT for unresectable PHC within defined criteria were randomized to adjuvant gemcitabine (LT-Gem group) and LT alone (LT alone group). The primary objective was to investigate if adjuvant chemotherapy is feasible in ≥ 85% of patients after LT. The primary endpoint was the percentage of patients completing the 24 weeks course of adjuvant chemotherapy. Secondary endpoints included overall survival (OS) and disease-free (DFS), and complication rates.ResultsTwelve patients underwent LT for PHC, of which six (50%) were eligible for randomization (LT-Gem: three patients, LT alone: three patients). Two out of three patients discontinued adjuvant chemotherapy after LT due to intolerance. The study was prematurely terminated due to slow enrollment. One patient with PHC had underlying primary sclerosing cholangitis (PSC). Tumor-free margins could be achieved in all patients. In both the LT-Gem and the LT alone group, the cumulative 1-, 3-, and 5-year OS and DFS rates were 100%, 100%, 67%, and 100%, 67% and 67%, respectively.ConclusionsThis prospective, multi-center study was prematurely terminated due to slow enrollment and a statement on the defined endpoints cannot be made. Nevertheless, long-term survival data are consistent with available retrospective data and confirm defined criteria for LT. Since more evidence of LT per se in unresectable PHC is urgently needed, a prospective, non-randomized follow-up study (pro-duct002) has since been launched.

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Section: Discussionmentioning

confidence: 99%

Feasibility and Efficacy of Adjuvant Chemotherapy With Gemcitabine After Liver Transplantation for Perihilar Cholangiocarcinoma - A Multi-Center, Randomized, Controlled Trial (pro-duct001)

Schmelzle

Benzing²,

Fischer³

et al. 2022

Front. Oncol.

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“…These cases are usually small tumors without vascular invasion. Since 2000, multiple heterogeneous series have been published and are summarized in Table 2 [10][11][12][13]. These retrospective studies helped identify the subgroup of patients that had long-term survival.…”

Section: Cirrhotic Patients With Incidental or 'Very Early' (< -2 Cm)...mentioning

confidence: 99%

Liver transplantation for intrahepatic cholangiocarcinoma: who, when and how

Achurra,

Fernandes,

O’Kane

et al. 2024

Current Opinion in Organ Transplantation

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Purpose of review Using transplant oncology principles, selected patients with intrahepatic cholangiocarcinoma (iCCA) may achieve long-term survival after liver transplantation. Strategies for identifying and managing these patients are discussed in this review. Recent findings Unlike initial reports, several modern series have reported positive outcomes after liver transplantation for iCCA. The main challenges are in identifying the appropriate candidates and graft scarcity. Tumor burden and response to neoadjuvant therapies have been successfully used to identify favorable biology in unresectable cases. New molecular biomarkers will probably predict this response in the future. Also, new technologies and better strategies have been used to increase graft availability for these patients without affecting the liver waitlist. Summary Liver transplantation for the management of patients with unresectable iCCA is currently a reality under strict research protocols. Who is a candidate for transplantation, when to use neoadjuvant and locoregional therapies, and how to increase graft availability are the main topics of this review.

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“…Surgery to remove the liver and replace it with one from a donor may be an option for people with iCCA (combined to neoadjuvant chemotherapy) [14] and pCCA [15].…”

Section: Liver Trans-plantationmentioning

confidence: 99%

Cold plasma endoscopy applied to biliary ducts: feasibility risk assessment on human-like and porcine models for the treatment of cholangiocarcinoma

Decauchy

Pavy

Camus

et al. 2022

J. Phys. D: Appl. Phys.

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For the past twelve years, cold plasmas (i.e., weakly ionized gas) have been positioned as a breakthrough technology for treating cancer thanks to their antitumor properties. The innovation of ad hoc plasma sources and personalized protocols appears crucial to treat cancers with a very poor prognosis. This is the case for cholangiocarcinoma (CCA), a biliary tract cancer, whose treatment with cold plasma is envisioned but requires the innovation of catheters and endoscopic devices for local therapies. Before conducting clinical trials, the performances and limitations of cold plasma endoscopy must be evaluated in terms of safety for both the patient and clinician as well as in terms of therapeutic efficacy. These objectives are pursued in the present work, in which a transferred plasma catheter is used, powered by 8-10 kV, 1-2 µs wide, 5-10 kHz repeated pulses, allowing guided streamers to be transferred over lengths of at least 2 m. In a first step, the catheter is utilized without the duodenoscope and directly inserted into an artificial model reproducing the topography and the electrical response of the biliary tree. This model allows to validate the technical feasibility of the technology and to demonstrate the absence of electrical and thermal risks. Indeed, the voltage and current deposited are as low as 3.98 V and 1.19 mA (RMS values) respectively, while the temperature locally increases from 23°C to 27 °C. In a second step, the catheter is inserted into the duodenoscope, the whole being applied to a porcine anatomical model. After passing through the esophagus, stomach and duodenum, the distal part of the duodenoscope is placed at the entrance to the papilla so that the catheter can easily enter the choledoc and then the common bile duct. Interestingly, the electrical power values deposited are of the order of 100 mW especially because the current values are at least 10 times higher. These more elevated values of electrical parameters but also electromagnetic effects are discussed considering physical aspects like eddy currents. The absence of electrical and thermal risks is demonstrated and consolidated by the IEC standards for medical devices. In a third time, we demonstrate that the cold plasma catheter can induce antitumor effects on in vitro experimental models of human CCA. The methodology proposed in this article validates the relevance of cold plasma endoscopy as a potential local treatment for cholangiocarcinoma and allows bridging cognitive and patient-oriented research.

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Liver Transplantation for Intrahepatic Cholangiocarcinoma: What Are New Insights and What Should We Follow?

Cited by 6 publications

References 30 publications

Feasibility and Efficacy of Adjuvant Chemotherapy With Gemcitabine After Liver Transplantation for Perihilar Cholangiocarcinoma - A Multi-Center, Randomized, Controlled Trial (pro-duct001)

Feasibility and Efficacy of Adjuvant Chemotherapy With Gemcitabine After Liver Transplantation for Perihilar Cholangiocarcinoma - A Multi-Center, Randomized, Controlled Trial (pro-duct001)

Liver transplantation for intrahepatic cholangiocarcinoma: who, when and how

Cold plasma endoscopy applied to biliary ducts: feasibility risk assessment on human-like and porcine models for the treatment of cholangiocarcinoma

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