Adjuvant Concurrent Chemoradiotherapy in Extrahepatic Cholangiocarcinoma

Treatment with 6 months of adjuvant capecitabine chemotherapy is currently the standard of care in patients with resected extrahepatic cholangiocarcinoma (CCA).¹ However, the benefit of treatment with adjuvant radiation therapy is not well-defined.

Using data from the National Cancer Database, a study presented at the 2020 ASCO annual meeting evaluated survival outcomes with adjuvant chemoradiotherapy compared with chemotherapy alone in patients with extrahepatic CCA.² The study was led by Walid L. Shaib, MD, Medical Oncologist, Winship Cancer Institute of Emory University, Atlanta, GA.

Patients who had resected stage I to stage III extrahepatic CCA between 2004 and 2013 were identified from the National Cancer Database. Patients who had received neoadjuvant therapy were excluded from this analysis. Univariate and multivariable analyses were conducted, and Kaplan-Meier curves were used to compare the overall survival (OS) of the patients based on the treatment received.

The investigators identified 236 patients with extrahepatic CCA, including 68 (28.8%) patients with stage I disease, 134 (56.8%) with stage II disease, and 34 (14.4%) with stage III disease.

A total of 89 (37.7%) patients received adjuvant chemotherapy and 147 (62.3%) patients received adjuvant chemoradiotherapy. The median dose of radiation was 50.4 Gy. Adjuvant chemoradiotherapy was predominantly used in patients with regional node-positive disease (P = .016) and in patients with negative surgical margins (P = .002).

The use of adjuvant chemoradiotherapy was associated with improved OS compared with chemotherapy alone in univariate (hazard ratio, 0.64; P = .019) and multivariable (hazard ratio, 0.65; P = .030) analyses. The median OS was 33.8 months and the 1-year OS rate was 87.7% for patients who received chemoradiotherapy compared with 23.8 months and 75.5%, respectively, in patients who received chemotherapy alone.

The investigators concluded that adjuvant chemoradiotherapy was associated with improved survival in patients with resected extrahepatic CCA compared with chemotherapy alone.

References

1. Primrose JN, Fox RP, Palmer DH, et al; for the BILCAP study group. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 2019;20:663-673. Erratum in: Lancet Oncol. 2019;20:e242.
2. Shaib WL, Zakka KM, Tian F, et al. Adjuvant concurrent chemoradiotherapy in extrahepatic cholangiocarcinoma. J Clin Oncol. 2020;38(15_suppl):Abstract 4583.