The Future of Neoadjuvant Chemotherapy for iCCA

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.