Euroasian journal of hepato-gastroenterology

Register      Login

VOLUME 14 , ISSUE 1 ( January-June, 2024 ) > List of Articles

Original Article

Treatment Response and Survival with Chemotherapy for Unresectable, Nonmetastatic Cholangiocarcinoma

Ajay Gupta, Puja Sahai, Manya Prasad, Hanuman Prasad Yadav, Gagan Srivastava, Nuneno Nakhro, Guresh Kumar, Namita Sharma

Keywords : Biliary tract neoplasms, Biliary tract cancers, Cholangiocarcinoma, Chemotherapy, Unresectable

Citation Information : Gupta A, Sahai P, Prasad M, Yadav HP, Srivastava G, Nakhro N, Kumar G, Sharma N. Treatment Response and Survival with Chemotherapy for Unresectable, Nonmetastatic Cholangiocarcinoma. Euroasian J Hepatogastroenterol 2024; 14 (1):5-8.

DOI: 10.5005/jp-journals-10018-1396

License: CC BY-NC 4.0

Published Online: 12-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background and objectives: Limited studies have dwelt upon the treatment of unresectable, nonmetastatic cholangiocarcinoma as a separate entity. Hence, the management protocols are not clearly defined for this subgroup of patients. We aimed to analyze patients treated for unresectable, nonmetastatic cholangiocarcinoma. Materials and methods: We analyzed the treatment of patients with unresectable, nonmetastatic cholangiocarcinoma retrospectively. Results: A total of 162 cases of cholangiocarcinoma were reported to our center from 2016 to 2019, out of which 54 were unresectable and nonmetastatic. Thirty patients opted for treatment and were the subjects of this study. Of 30 patients, 24 had hyperbilirubinemia, out of which 10 received chemotherapy after biliary drainage procedure. Out of 30 patients, a total of 16 patients had received chemotherapy, while 14 did not. Gemcitabine/Cisplatin was the first-line chemotherapy administered to 9 patients, whereas 5 received Gemcitabine/Capecitabine and 2 received single-agent gemcitabine. Partial response was documented in 6 patients, and 4 patients had stable disease. The median overall survival was 12.04 months in patients who had received chemotherapy and 6.02 months in those who did not receive chemotherapy (p = 0.005). The median progression-free survival was 6.53 months for patients who had received chemotherapy. The aHR for mortality with chemotherapy compared with no chemotherapy was 0.353 (95% CI: 0.154–0.807). Conclusion: The study data demonstrate that gemcitabine combined with cisplatin- or capecitabine-based chemotherapy prolongs survival in patients with unresectable and nonmetastatic cholangiocarcinoma. In patients with cholangiocarcinoma associated with jaundice, biliary drainage procedure enables giving chemotherapy. Hyperbilirubinemia persisting despite drainage procedures portends poor prognosis and represents an unmet need.


PDF Share
  1. Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis 1994;14(2):109–114. DOI: 10.1055/s-2007-1007302.
  2. Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine vs gemcitabine for biliary tract cancer. N Engl J Med 2010;362(14): 1273–1281. DOI: 10.1056/NEJMoa0908721.
  3. Kim YI, Park JW, Kim BH, et al. Outcomes of concurrent chemoradiotherapy vs chemotherapy alone for advanced-stage unresectable intrahepatic cholangiocarcinoma. Radiat Oncol 2013;8:292. DOI: https://doi.org/10.1186/1748-717X-8-292.
  4. Chen YX, Zeng ZC, Tang ZY, et al. Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma: A retrospective analysis of 84 patients. BMC Cancer 2010;10:492. DOI: 10.1186/1471-2407-10-492.
  5. Tao R, Krishnan S, Bhosale PR, et al. Ablative radiotherapy doses lead to a substantial prolongation of survival in patients with inoperable intrahepatic cholangiocarcinoma: A retrospective dose response analysis. J Clin Oncol 2016;34(3):219–226. DOI: 10.1200/JCO.2015.61.3778.
  6. Ohnishi H, Asada M, Shichijo Y, et al. External radiotherapy for biliary decompression of hilar cholangiocarcinoma. Hepatogastroenterology 1995;42(3):265–268. PMID: 7590576.
  7. Park JY, Park SW, Chung JB, et al. Concurrent chemoradiotherapy with doxifluridine and paclitaxel for extrahepatic bile duct cancer. Am J Clin Oncol 2006;29(3):240–245. DOI: 10.1097/01.coc.0000217829.77404.22.
  8. Baisden JM, Kahaleh M, Weiss GR, et al. Multimodality treatment with helical tomotherapy intensity modulated radiotherapy, capecitabine, and photodynamic therapy is feasible and well tolerated in patients with hilar cholangiocarcinoma. Gastrointest Cancer Res 2008;2(5):219–224. PMID: 19259306.
  9. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 2009;45(2):228–247. DOI: 10.1001/jamaoncol.2021.3836.
  10. Sandler KA, Veruttipong D, Agopian VG, et al. Stereotactic body radiotherapy (SBRT) for locally advanced extrahepatic and intrahepatic cholangiocarcinoma. Adv Radiat Oncol 2016;1(4): 237–243. DOI: 10.1016/j.adro.2016.10.008.
  11. Drilon A, Laetsch TW, Kummar S, et al. Efficacy of larotrectinib in TRK fusion-positive cancers in adults and children. N Engl J Med 2018;378(8):731–739. DOI: 10.1056/NEJMoa1714448.
  12. Subbiah V, Lassen U, Élez E, et al. Dabrafenib plus trametinib in patients with BRAFV600E-mutated biliary tract cancer (ROAR): A phase 2, open label, single-arm, multicentre basket trial. Lancet Oncol 2020;21(9):1234–1243. DOI: 10.1016/S1470-2045(20)30321-1.
  13. Abou-Alfa GK, Sahai V, Hollebecque A, et al. Pemigatinib for previously treated, locally advanced or metastatic cholangiocarcinoma: A multicentre, open-label, phase 2 study. Lancet Oncol 2020;21(5): 671–684. DOI: 10.1016/S1470-2045(20)30109-1.
  14. Zhu AX, Macarulla T, Javle MM, et al. Final overall survival efficacy results of ivosidenib for patients with advanced cholangiocarcinoma with IDH1 mutation: The phase 3 randomized clinical ClarIDHy trial. JAMA Oncol 2021;7(11):1669–1677. DOI: 10.1001/jamaoncol.2021.3836.
  15. Marabelle A, Le DT, Ascierto PA, et al. Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair-deficient cancer: Results from the phase II KEYNOTE-158 study. J Clin Oncol 2020;38(1):1–10. DOI: 10.1200/JCO.19.02105.
  16. Piha-Paul SA, Oh DY, Ueno M, et al. Efficacy and safety of pembrolizumab for the treatment of advanced biliary cancer: Results from the KEYNOTE-158 and KEYNOTE-028 studies. Int J Cancer 2020;147(18):2190–2198. DOI: 10.1002/ijc.33013.
  17. Philip PA, Mahoney MR, Allmer C, et al. Phase II study of erlotinib in patients with advanced biliary cancer. J Clin Oncol 2006;24(19): 3069–3074. DOI: 10.1200/JCO.2005.05.3579.
  18. Lubner SJ, Mahoney MR, Kolesar JL, et al. Report of a multicenter phase II trial testing a combination of biweekly bevacizumab and daily erlotinib in patients with unresectable biliary cancer: A phase II Consortium study. J Clin Oncol 2010;28(21):3491–3497. DOI: 10.1200/JCO.2010.28.4075.
  19. Iyer RV, Pokuri VK, Groman A, et al. A multicenter phase II study of gemcitabine, capecitabine, and bevacizumab for locally advanced or metastatic biliary tract cancer. Am J Clin Oncol 2018;41(7):649–655. DOI: 10.1097/COC.0000000000000347.
  20. Gruenberger B, Schueller J, Heubrandtner U, et al. Cetuximab, gemcitabine, and oxaliplatin in patients with unresectable advanced or metastatic biliary tract cancer: A phase 2 study. Lancet Oncol 2010;11(12):1142–1148. DOI: 10.1016/S1470-2045(10)70247-3.
  21. Leone F, Marino D, Cereda S, et al. Panitumumab in combination with gemcitabine and oxaliplatin does not prolong survival in wild-type KRAS advanced biliary tract cancer: A randomized phase 2 trial (Vecti-BIL study). Cancer 2016;122(4):574–581. DOI: 10.1002/cncr.29778.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.