Successful treatment of colorectal liver metastasis harboring intrahepatic cholangiocarcinoma

Cheng, Xiaofei; Zhao, Feng; Chen, Dong; Yang, P C; Zhong, Weixia; Xu, Xiao; Wang, Weilin

doi:10.1097/md.0000000000013751

Cited by 5 publications

(4 citation statements)

References 31 publications

(30 reference statements)

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“…A controlled clinical trial reported longer PFS times in the bevacizumab combination group (6.48 months) than in the GEMOX group (3.72 months) [25]. There are cases of ICCs being successfully treated with bevacizumab combined with oxaliplatin-based chemotherapies as a consequence of misdiagnosed colorectal carcinoma liver metastasis [26,27]. Evidence supporting neoadjuvant or conversional treatment in ICC is lacking, but our results showed that late staged patients accepted combination of chemotherapy and bevacizumab treatment and consecutive operation had a longer PFS time than those underwent radical surgery.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive molecular profiling of intrahepatic cholangiocarcinoma in the Chinese population and therapeutic experience

et al. 2020

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Background: The genomic alterations of intrahepatic cholangiocarcinoma (ICC) in the Chinese population have not been fully revealed. Molecular profiling may provide a reference for clinical management, especially targeted therapy. Methods: A retrospective study was conducted in 122 ICC patients. All patients' samples underwent next-generation sequencing (NGS), which analyzed 417 genes. The genetic characteristics, clinical management and therapeutic responses were analyzed. Results: The most commonly mutated genes were TP53 (34%), KRAS (25%) and ARID1A (17%). Targeted agents were used referring to molecular profiling, in combination with chemotherapy. Twenty-two patients with wild-type KRAS/ NRAS/BRAF were treated with cetuximab. The disease control and response rates were 78% and 47%, respectively, which were higher than those achieved with chemotherapy alone (72% and 11%, P = 0.16). Fifty-four patients underwent anti-VEGF treatment with bevacizumab. The disease control and response rates were 85% and 60%, respectively. Better therapeutic efficiency (P = 0.001) and longer progression-free survival (PFS) were observed in the bevacizumabtreated group compared to chemotherapy alone group (15.4 and 6.7 months, respectively; P = 0.04). The PFS of ten patients who underwent hepatectomy after combined treatment with chemotherapy and bevacizumab was longer than that of 139 patients who underwent surgical treatment (28.9 vs 18.0 months, P = 0.03). Two patients (1.6%) had signatures of microsatellite instability (MSI-H), and both benefited from immunotherapy. Conclusions: This study provides an overview of genetic alterations in Chinese ICC patients and indicates the potential clinical implications for NGS-based personalized therapies.

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Section: Discussionmentioning

confidence: 99%

Comprehensive molecular profiling of intrahepatic cholangiocarcinoma in the Chinese population and therapeutic experience

et al. 2020

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“…A review including several RCT has supported the effectiveness and similar oncologic outcomes of MI colectomy compared with open surgery in the setting of isolated colon cancer [96]. As of lymphadenectomy, revision of four casematched studies comparing MI and open approach including a total of 75 matched patients, showed no significant differences regarding adequacy of lymphadenectomy (including harvested lymph nodes) between the two approaches [29,36,61,97].…”

Section: Grade Of Recommendation Bmentioning

confidence: 99%

The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: A Delphi methodology

et al. 2021

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At the time of diagnosis synchronous colorectal cancer, liver metastases (SCRLM) account for 15-25% of patients. If primary tumour and synchronous liver metastases are resectable, good results may be achieved performing surgical treatment incorporated into the chemotherapy regimen. So far, the possibility of simultaneous minimally invasive (MI) surgery for SCRLM has not been extensively investigated. The Italian surgical community has captured the need and undertaken the effort to establish a National Consensus on this topic. Four main areas of interest have been analysed: patients' selection, procedures, techniques, and implementations. To establish consensus, an adapted Delphi method was used through as many reiterative rounds were needed. Systematic literature reviews were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instructions. The Consensus took place between February 2019 and July 2020. Twenty-six Italian centres participated. Eighteen clinically relevant items were identified. After a total of three Delphi rounds, 30-tree recommendations reached expert consensus establishing the herein presented guidelines. The Italian Consensus on MI surgery for SCRLM indicates possible pathways to optimise the treatment for these patients as consensus papers express a trend that is likely to become shortly a standard procedure for clinical pictures still on debate. As matter of fact, no RCT or relevant case series on simultaneous treatment of SCRLM are available in the literature to suggest guidelines. It remains to be investigated whether the MI technique for the simultaneous treatment of SCRLM maintain the already documented benefit of the two separate surgeries.

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“…The review emphasized the significance of MDTs in developing tailored treatment plans and optimizing patient management, stressing the importance of a collaborative and comprehensive approach to address the complexities of CRLM[ 45 ]. Moreover, Cheng et al [ 46 ] highlighted the importance of a multidisciplinary treatment plan in achieving successful resection of colorectal liver metastases and intrahepatic cholangiocarcinoma, further emphasizing the role of MDTs in guiding complex treatment decisions[ 46 ].…”

Section: The Crucial Role Of Mdt In Customizing Individualized Approa...mentioning

confidence: 99%

Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis

Cheng,

Zhao,

Chen

et al. 2024

World J Gastroenterol

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Colorectal cancer liver metastasis (CRLM) presents a clinical challenge, and optimizing treatment strategies is crucial for improving patient outcomes. Surgical resection, a key element in achieving prolonged survival, is often linked to a heightened risk of recurrence. Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases, this approach has gained attention for its role in tumor downsizing, assessing biological behavior, and reducing the risk of postoperative recurrence. However, the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates. The balance between tumor reduction and the risk of hepatic injury, coupled with concerns about delaying surgery, necessitates a nuanced approach. This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases. Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion. Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative. The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing, such as RAS/BRAF and PIK3CA, in tailoring neoadjuvant regimens. Furthermore, the review emphasizes the need for a multidisciplinary approach to navigate the complexities of CRLM. Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies. The management of progression following neoadjuvant chemotherapy requires a tailored approach, acknowledging the diverse biological behaviors that may emerge. In conclusion, this review aims to provide a comprehensive perspective on the considerations, challenges, and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM. By combining evidence-based insights with practical experiences, we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.

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Successful treatment of colorectal liver metastasis harboring intrahepatic cholangiocarcinoma

Cited by 5 publications

References 31 publications

Comprehensive molecular profiling of intrahepatic cholangiocarcinoma in the Chinese population and therapeutic experience

Comprehensive molecular profiling of intrahepatic cholangiocarcinoma in the Chinese population and therapeutic experience

The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: A Delphi methodology

Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis

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