The Future of Neoadjuvant Chemotherapy for iCCA

2022 Year in Review: Cholangiocarcinoma — January 4, 2023

Intrahepatic cholangiocarcinoma (iCCA) is typically managed by upfront resection in suitable candidates. However, there is an interest in using neoadjuvant chemotherapy to reduce recurrence rates and improve outcomes. Dr Rebecca Marcus of the Providence Saint John’s Cancer Institute in the United States presented data on the role of neoadjuvant chemotherapy in patients with iCCA as predictors of treatment regimen and oncologic outcomes.

In this study, the investigators used a population-based National Cancer Database to identify patients with clinical stage I-III iCCA who underwent curative intent surgery between 2006 and 2016. These patients were then stratified to different cohorts: surgery alone, neoadjuvant therapy followed by surgery, or surgery with adjuvant therapy. Results from this study were shared at the 2022 International Hepato-Pancreato-Biliary Association World Congress.

In a cohort of 2700 patients with resectable iCCA, the use of neoadjuvant therapy was low overall but increased over the study period (4.3% to 7.2% by the end of the study period). In terms of predictive factors, higher clinical stage was predictive of neoadjuvant therapy, whereas higher pathologic stage and positive resection margins were predictive of adjuvant therapy. Overall, the risk of death from iCCA decreased over the study period, which was attributed to improvements in surgical technique. In addition, neoadjuvant therapy was associated with a decrease in the incidence of margin-positive resection.

Dr Marcus concluded that “utilization of neoadjuvant chemotherapy for the treatment of iCCA has certainly increased and the risk of death has decreased. Neoadjuvant therapy did decrease the incidence of margin-positive resections, which may have contributed to improved survival.”

Flavio Rocha, MD, FACS, FSSP, Physician-in-Chief of the Knight Cancer Institute, commented, “What we do know is that prospective studies for neoadjuvant therapy are being conducted, and we hope that this will emerge as a new treatment strategy in the management of iCCA.”

Source: Marcus R, Christopher W, Nassoiy S, et al. Neoadjuvant chemothe rapy is associated with lower rates of margin-positive resection of intrahepatic cholangiocarcinoma. International Hepato-Pancreato-Biliary Association World Congress 2022. Abstract FP16-7.

Related Items

KEYNOTE-966: Pembrolizumab Combined With GemCis Versus GemCis Alone in Patients With BTC
2023 Year in Review: Cholangiocarcinoma
In the KEYNOTE-966 study, pembrolizumab was added to gemcitabine/cisplatin to assess outcomes in patients with advanced biliary tract cancer.
Post-hoc Analysis of the ABC-01, -02, and -03 Trials in Patients With Advanced eCCA
2023 Year in Review: Cholangiocarcinoma
This post-hoc analysis of the ABC-01, -02, and -03 clinical trials provides reference survival data for patients with advanced extrahepatic cholangiocarcinoma treated with first-line gemcitabine/cisplatin chemotherapy.
Efficacy and Safety of Tinengotinib in Patients With Advanced Refractory/Relapsed CCA Who Previously Received an FGFR Inhibitor
2023 Year in Review: Cholangiocarcinoma
Investigators pooled data from 3 trials to evaluate tinengotinib in patients with advanced, refractory/relapsed cholangiocarcinoma who previously received an FGFR inhibitor.
KLF5 Inhibition Reduces Tumor Growth and Sensitizes to Chemotherapy-Induced Cell Death in Experimental Models of CCA
2023 Year in Review: Cholangiocarcinoma
Researchers evaluated KLF5 expression and its inhibition in cholangiocarcinoma using clustered regularly interspaced short palindromic repeats technology.
Phase 2 Trial of SHR-1316 Plus IBI310 in Patients With Advanced iCCA After Inadequate Response to First-Line Therapy
2023 Year in Review: Cholangiocarcinoma
In this ongoing phase 2 study, the efficacy of SHR-1316 plus IBI310 is being evaluated in patients with advanced intrahepatic cholangiocarcinoma after inadequate response to first-line therapy.
Examination of Patients With CCA Treated With Novel Targeted Therapies After Extended Molecular Profiling on Liquid Biopsies
2023 Year in Review: Cholangiocarcinoma
Dr Mahmood presented results from the largest multi-institutional review of efficacy outcomes following targeted agents in patients with cholangiocarcinoma.
Phase 2 Component of the BEER-BTC Study: Comparing Bevacizumab Plus Erlotinib Maintenance Versus Observation in Patients With Advanced BTC
2023 Year in Review: Cholangiocarcinoma
In the phase 2 component of the phase 2/3 BEER-BTC study, bevacizumab plus erlotinib improved outcomes in patients with advanced biliary tract cancers.
The DEBATE Trial: Neoadjuvant Durvalumab Plus GemCis Versus GemCis Alone for Patients With Localized BTC
2023 Year in Review: Cholangiocarcinoma
Researchers investigated the efficacy and safety of neoadjuvant durvalumab plus gemcitabine/cisplatin (GemCis) versus GemCis alone in patients with biliary tract cancer.
The Phase 2 ADJUBIL Study of Durvalumab Plus Tremelimumab With or Without Capecitabine in BTC
2023 Year in Review: Cholangiocarcinoma
In the ongoing phase 2 ADJUBIL study, the clinical activity of immunotherapies durvalumab and tremelimumab with or without capecitabine is being assessed in patients with resectable biliary tract cancer in the adjuvant setting.
Tucatinib and Trastuzumab in Patients With Previously Treated HER2-Positive Metastatic BTC: The SGNTUC-019 Study
2023 Year in Review: Cholangiocarcinoma
This phase 2 basket study investigated the combination of tucatinib and trastuzumab as second-line treatment for patients with HER2-positive biliary tract cancer.

Subscribe Today!

To sign up for our newsletter or print publications, please enter your contact information below.

I'd like to receive: