Curative Surgery After 3-Drug Chemotherapy Regimen Extends Survival in Patients with Locally Advanced CCA

The current standard first-line therapy for advanced cholangiocarcinoma (CCA) is the chemotherapy combination of gemcitabine plus cisplatin; only about 40% of patients are amenable to surgery. The objective of this retrospective study was to evaluate the clinical feasibility of the triplet chemotherapy regimen of nab-paclitaxel plus gemcitabine and cisplatin as first-line therapy in patients with locally advanced CCA.

The results were presented by Sung Hoon Choi, BA, CHA University, Seongnam-Si, South Korea, at the 2022 ASCO GI Cancers Symposium.

This retrospective analysis was based on a chart review of patients with locally advanced CCA who received the triplet regimen of nab-paclitaxel plus gemcitabine and cisplatin between October 2019 and December 2020. The feasibility of resection after induction chemotherapy was evaluated by a multidisciplinary team.

The investigators assessed the perioperative outcomes and pathologic results of surgical resection after induction chemotherapy.

Of the 85 patients in this study, 46 (54.1%) patients had measurable lesions, 24 patients had a diagnosis of intrahepatic CCA, 37 had extrahepatic/perihilar CCA, and 24 had extrahepatic/distal CCA.

In the overall population, after induction chemotherapy, the objective response rate in patients with measurable disease was 51.1%, and the disease control rate was 85.1%. Of the 85 patients in the study, 52 (61.2%) patients had resectable tumors.

Among all the patients in this study, 48 (56.5%) patients underwent subsequent curative surgery. In the subset of patients who underwent surgery, 6 (12.5%) achieved complete remissions (all in extrahepatic CCA); R0 resection was achieved in 43 (89.6%) patients.

The overall survival (OS) rates were significantly higher among patients who had induction chemotherapy followed by surgery compared with those who received chemotherapy alone, with a 12-month OS of 94.9% versus 72.6%, respectively (P = .009).

These data support the clinical feasibility of induction chemotherapy with nab-paclitaxel plus gemcitabine and cisplatin before curative surgery in patients with locally advanced CCA.

Source

Choi SH, Kang B, Cheon J, et al. Clinical feasibility of curative surgery after nab-paclitaxel plus gemcitabine-cisplatin chemotherapy in patients with locally advanced cholangiocarcinoma. Abstract 387.