By Will Boggs MD
NEW YORK (Reuters Health) - 19/9/2019
Liver-directed local therapy is associated with improved overall survival in adults with metastatic and intrahepatic cholangiocarcinoma, according to findings from the National Cancer Database (NCDB).
"Treatment of the primary (tumor) in metastatic cholangiocarcinoma has been traditionally underperformed as survival was thought to be driven by the burden of distant disease," said Dr. Alexandra Diaz of The Ohio State University, in Columbus.
"However, this study highlights that liver-directed therapy perhaps could benefit these patients," she told Reuters Health by email.
Systemic therapy with consideration of locoregional therapy is the standard of care for advanced or metastatic intrahepatic cholangiocarcinoma (ICC), whose median overall survival is only 12 months.
Dr. Diaz's team used NCDB information from 2,201 patients with metastatic ICC, 2,097 of whom received chemotherapy alone and 104 of whom received chemotherapy with liver-directed local therapy (LDLT) consisting of hepatic surgery in about three-quarters and irradiation in the rest.
Median overall survival was 8.3 months for chemotherapy alone versus 16.7 months for chemotherapy plus LDLT, the researchers report in in JAMA Network Open, online September 13.
In multivariable analysis, LDLT was associated with a 40% lower risk of death (P<0.001), with no significant difference between patients in the LDLT group treated with hepatic irradiation versus surgical resection.
Other factors independently associated with better survival included female sex and treatment at an academic facility, whereas factors associated with worse survival included higher comorbidity scores, presence of bone metastases, and presence of lung metastases.
Significantly improved overall survival associated with LDLT was evident among patients who lived longer than three months, six months and 12 months in sequential-landmark analysis.
"This study demonstrates that local therapy may benefit some patients with stage IV cholangiocarcinoma, who have traditionally been considered candidates for systemic therapy only," Dr. Diaz said.
"Given the retrospective nature of the data and the limited number of patients, the routine use of local therapy for patients with stage IV cholangiocarcinoma cannot be recommended yet," she said. "A clinical trial is required to validate these findings, and it is currently under development."
In an email written jointly with co-author Dr. Terence M. Williams, Dr. Diaz added, "Given the relative rarity of cholangiocarcinoma, these patients should be treated at a specialized cancer center with expertise, preferably as part of a clinical trial, so that we can offer the most advanced treatments and learn more about this difficult cancer."
JAMA Netw Open 2019.
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