The Addition of Transarterial Chemoembolization to Palliative Chemotherapy Extends Survival in Intrahepatic Cholangiocarcinoma

Abstract

Incidence and mortality of intrahepatic cholangiocarcinoma (iCCA) have been increasing continuously. Recent studies suggest that the combination of palliative chemotherapy (pCTX) and transarterial chemoembolization (TACE) improves overall survival (OS). This study aimed to evaluate the outcome of patients treated with TACE and pCTX in unresectable iCCA at our tertiary care center. A group of 14 patients was treated with both pCTX and TACE. The non-randomized control group of 59 patients received pCTX alone. Patients received a median of two pCTX lines in both groups. Those treated with TACE underwent a median number of 3.5 sessions. Median OS from the time of unresectability was 26.2 months in the pCTX + TACE group versus 13.1 months in the pCTX group (p = 0.008). Controlling for albumin, bilirubin, ECOG (Eastern Cooperative Oncology Group) performance status, and UICC (Union for International Cancer Control) stage, the addition of TACE still conferred an OS benefit of 12.95 months (p = 0.014). A propensity score matching analysis yielded an OS benefit of 14 months from the time of unresectability for the pCTX + TACE group (p = 0.020). The addition of TACE to pCTX may provide an OS benefit for patients with unresectable iCCA. Thus, patients with liver-dominant iCCA undergoing standard-of-care pCTX should be considered for additional treatment with TACE.

Locoregional therapy combined with systemic therapy (LRT + ST) for unresectable and metastatic intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

“…The score is rated out of 9 stars: >6 stars indicate a low risk of bias, 4-6 stars indicate a moderate risk of bias, and <4 stars indicate a high risk of bias. Out of the ten studies included [20][21][22][23][24][25][26][27][28][29] in the systematic review, three studies [24][25][26] were determined to be of good quality, and seven studies [20][21][22][23][27][28][29] were determined to be of acceptable quality. Details of the quality assessment are shown in Supplementary Table 2.…”

“…Ten cohort studies were deemed eligible and included in the descriptive analysis; of the 3,791 patients in these studies, 1,120 (29.5%) were treated with LRT + ST. ADT was performed in six articles 20,[22][23][24]27,28 , EBRT in three 25,26,29 , and ablation in one 21 (Table 1). Further details of the included literature are provided in Supplementary Table 3.…”

Don’t Judge a Book by Its Cover: The Role of Statins in Liver Cancer

“…Increasingly, chemo-or radio-embolization are also used to treat primary liver cancers. Unfortunately, these are also palliative methods aimed at extending survival and/or improving the quality of life [8][9][10].…”

Sulfasalazine Sensitizes Polyhematoporphyrin-Mediated Photodynamic Therapy in Cholangiocarcinoma by Targeting xCT

“…However, the early stage of CCA has no evident clinical symptoms, and thus, patients usually lose the opportunity to undergo surgical operation after diagnosis (KRASINSKAS, 2018), contributing to a survival period of non-surgery patients lower than 1 year (RERKNIMITR et al, 2013). However, research shows that patients with CCA with effective palliative treatment can have a longer survival period (GAIRING et al, 2021). Endoscopic stent is a well-known palliative treatment for persistent drainage of the bile duct (CILLO et al, 2019).…”