One discussion this week included using chemotherapy to enable initially unresectable intrahepatic cholangiocarcinoma (ICC) to be resectable.

Reference: Le Roy B, et al. Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. The British Journal of Surgery. 2018 Jun;105(7):839-847. doi: 10.1002/bjs.10641

Summary: Surgical resection is the standard treatment for ICC, with a 5-year survival rate of 25-35% for those presenting with potentially resectable disease. Those with initially unresectable ICC are treated with chemotherapy alone and have a poor prognosis (p.839). The strategy of conversion to secondary resectability through chemotherapy regimens has resulted in good long-term survival for other tumors (colorectal liver and neuroendocrine liver metastases).  The authors state there is no published data on the use of neoadjuvant chemotherapy to achieve secondary resectability in locally advanced ICC.

Le Roy et al (2018) conducted a retrospective analysis of 186 ICC patients treated at a hospital in France between January 2000 and December 2013. Patients were classified in three groups: surgery alone, surgery after neoadjuvant chemotherapy, and chemotherapy alone.

Neoadjuvant chemotherapy led to secondary resectability in over 50% of patients considered to have initially unresectable disease. Despite advanced disease at presentation, the overall and recurrence-free survival rates were not different between patient groups undergoing resection. In those with locally advanced ICC, secondary resection was associated with improvement in overall surival compared with those who received chemotherapy alone (p.845).

In conclusion, this study suggests that neoadjuvant chemotherapy may be considered an option for first-line treatment of patients with locally advanced ICC, resulting in similar morbidity, mortality, and long-term results compared with those patients with initially resectable disease (p.846).