Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma

Abstract

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and is increasing in incidence. Long-term outcomes are optimized when patients undergo margin-negative resection followed by adjuvant chemotherapy. Unfortunately, a significant proportion of patients present with locally advanced, unresectable disease. Furthermore, recurrence rates are high even among patients who undergo surgical resection. The delivery of systemic and/or liver-directed therapies prior to surgery may increase the proportion of patients who are eligible for surgery and reduce recurrence rates by prioritizing early systemic therapy for this aggressive cancer. Nevertheless, the available evidence for neoadjuvant therapy in ICC is currently limited yet recent advances in liver directed therapies, chemotherapy regimens, and targeted therapies have generated increasing interest its role. In this article, we review the rationale for, current evidence for, and ongoing research efforts in the use of neoadjuvant therapy for ICC.

Keywords: Biliary tract cancer; Conversion therapy; Down-staging; Hepatectomy; Liver resection; Preoperative therapy.

Figure 1

Locally advanced intrahepatic cholangiocarcinoma. A and B: 48F with large, multifocal intrahepatic cholangiocarcinoma who received 5 cycles of neoadjuvant gemcitabine/cisplatin; C and D: She experienced an excellent response and underwent extended left hepatectomy with pathology showing T2N0 moderately differentiated cholangiocarcinoma with negative margins.