The Recent Trends of Systemic Treatments and Locoregional Therapies for Cholangiocarcinoma

Abstract

Cholangiocarcinoma (CCA) is a hepatic malignancy that has a rapidly increasing incidence. CCA is anatomically classified into intrahepatic (iCCA) and extrahepatic (eCCA), which is further divided into perihilar (pCCA) and distal (dCCA) subtypes, with higher incidence rates in Asia. Despite its rarity, CCA has a low 5-year survival rate and remains the leading cause of primary liver tumor-related death over the past 10-20 years. The systemic therapy section discusses gemcitabine-based regimens as primary treatments, along with oxaliplatin-based options. Second-line therapy is limited but may include short-term infusional fluorouracil (FU) plus leucovorin (LV) and oxaliplatin. The adjuvant therapy section discusses approaches to improve overall survival (OS) post-surgery. However, only a minority of CCA patients qualify for surgical resection. In comparison to adjuvant therapies, neoadjuvant therapy for unresectable cases shows promise. Gemcitabine and cisplatin indicate potential benefits for patients awaiting liver transplantation. The addition of immunotherapies to chemotherapy in combination is discussed. Nivolumab and innovative approaches like CAR-T cells, TRBAs, and oncolytic viruses are explored. We aim in this review to provide a comprehensive report on the systemic and locoregional therapies for CCA.

Keywords: cholangiocarcinoma; distal (dCCA); hepatic malignancy; intrahepatic (iCCA); perihilar (pCCA).

Figure 1

Anatomical classification of cholangiocarcinoma (CCA) based on its origin.

Figure 2

A comprehensive diagram of cholangiocarcinoma treatment options. IHC—immunohistochemistry, MRI—magnetic resonance imaging, CT—computed tomography, PET—positron emission tomography, ECOG—Eastern Cooperative Oncology Group, 5-FU—fluorouracil, dMMR-deficient DNA mismatch repair, MSI-H—microsatellite instability high.