Therapeutic options for intrahepatic cholangiocarcinoma

Abstract

Biliary tract cancer (BTC) is a heterogeneous group of cancers, which is composed of intrahepatic cholangiocarcinoma (ICCA), extrahepatic cholangiocarcinoma (ECCA), gallbladder cancers and ampullary carcinomas. While all anatomic subgroups are treated uniformly, our understanding about the pathogenesis has allowed us to reason that each group represents a clinically and genetically diverse disease.The majority of patients present with locally advanced or metastatic disease, where the standard treatment is combination systemic cytotoxic chemotherapy with gemcitabine and cisplatin. While most receive a clinical benefit from chemotherapy, patients eventually progress where no standardized therapies are available in the refractory setting. With the use of next generation sequencing, we have come to understand that ICCA is a diverse genomic disease with many actionable alterations that may serve as potential therapeutic targets. Further studies investigating the role of novel targeted agents (as a single agent or with combination chemotherapy) will hopefully provide additional treatment options for this highly lethal disease.

C-reactive protein : albumin ratio in patients with resectable intrahepatic cholangiocarcinoma

“…The clinical consequence of a high CAR in ICC is unclear. Median OS in patients with high CAR in resectable ICC was 34 months, compared with only about 12 months in patients with unresectable ICC 4,26 . Surgical treatment is beneficial for resectable ICC compared with alternative treatments.…”

Characterization of intrahepatic cholangiocarcinoma after curative resection: outcome, prognostic factor, and recurrence

“…However, the high incidence of postoperative recurrence as this study is a major concern influencing the overall outcome of patients with ICC after surgical resection. Although postoperative adjuvant chemotherapy might be beneficial for patients following surgical resection, there is no consensus of adjuvant treatment strategies in terms of chemotherapeutic protocol and regimens to diminish the risk of postoperative recurrence nowadays [ 22 ]. Despite not being an independent prognostic factor, patients who received adjuvant chemotherapy after liver resection had a shorter disease free interval than those without adjuvant chemotherapy in the univariate analysis of the study.…”

Case report: Conversion therapy for advanced intrahepatic cholangiocarcinoma using PD-1 inhibitor plus S-1 and nab-paclitaxel

“…First-line chemotherapy for advanced iCCA includes gemcitabine, a platinum derivative, nab-paclitaxel, and fluoropyrimidines ( 3 ). However, only a few chemotherapy studies on chemotherapy were designed for iCCA alone.…”