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. 2023 Nov 6;13(11):2170.
doi: 10.3390/life13112170.

Second-Line Chemotherapy for Intrahepatic Cholangiocarcinomas: What Is the Real Gain?

Ingrid Garajová  1 , Fabio Gelsomino  2 , Massimiliano Salati  2 , Anna Mingozzi  1 , Marianna Peroni  1 , Stefania De Lorenzo  3 , Alessandro Granito  4 , Francesco Tovoli  4 , Francesco Leonardi  1
Affiliations

Second-Line Chemotherapy for Intrahepatic Cholangiocarcinomas: What Is the Real Gain?

Ingrid Garajová et al. Life (Basel). .

Abstract

Background: The presence of actionable alterations in advanced biliary tract cancer patients opened new therapeutic possibilities for second-line treatments. However, for around 60% of the patients, chemotherapy remains the only therapeutic option. The aim of our study was to evaluate outcomes and prognostic parameters in patients with intrahepatic cholangiocarcinomas treated with second-line chemotherapy.

Methods: A total of 255 consecutive metastatic intrahepatic cholangiocarcinoma (ICC) patients were retrospectively reviewed and clinicopathologic and survival data were collected.

Results: Fourty-four percent of ICC patients underwent second-line chemotherapy. In particular, younger ICC patients with better ECOG PS status, and with disease control after first-line chemotherapy were those who were treated with second-line treatments. Median progression-free survival in the patients treated with second-line chemotherapy was 3 months. Finally, the patients affected by intrahepatic cholangiocarcinoma with better ECOG PS, with prior surgical resection of the primary tumor, who responded to first-line chemotherapy, and had better progression-free survival with second-line chemotherapy, were associated with better outcomes in multivariate analysis.

Conclusions: Not all patients seem to benefit from second-line chemotherapy. To improve therapeutic decisions, performance status and disease control with first-line chemotherapy should lead to the decision on the usefulness of second-line treatments in advanced ICC patients.

Keywords: intrahepatic cholangiocarcinoma; prognosis; second-line chemotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic view of PFS1, PFS2, and OS: PFS was defined as the time period from beginning first-line chemotherapy (PFS1) or second-line chemotherapy (PFS2) until disease progression. OS for metastatic disease was defined as the time period from the application of first-line palliative chemotherapy until death.
Figure 2
Figure 2
(a) Median OS of ICC patients depends on PFS1. The ICC patients with longer responses to first-line chemotherapy had a longer OS, p < 0.001. (b) Median OS depended on disease control after first-line chemotherapy. The patients with disease control after first-line chemotherapy had a longer OS, p < 0.001. (c) Median OS depended on PFS2, the patients with longer response to second-line chemotherapy had a longer OS, p = 0.002.
Figure 2
Figure 2
(a) Median OS of ICC patients depends on PFS1. The ICC patients with longer responses to first-line chemotherapy had a longer OS, p < 0.001. (b) Median OS depended on disease control after first-line chemotherapy. The patients with disease control after first-line chemotherapy had a longer OS, p < 0.001. (c) Median OS depended on PFS2, the patients with longer response to second-line chemotherapy had a longer OS, p = 0.002.
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