HAIP floxuridine chemotherapy has similar survival vs surgery in multifocal iCCA: JAMA
USA: In patients with multifocal intrahepatic cholangiocarcinoma (iCCA), the researchers found similar overall survival (OS) with a hepatic arterial infusion pump (HAIP) floxuridine chemotherapy vs resection, according to a cohort study.
The findings, published in JAMA Surgery indicate that there is a need for careful consideration of the resection of multifocal intrahepatic cholangiocarcinoma given the complication rate of major liver resection. And, HAIP floxuridine chemotherapy could be an effective alternative treatment option.
At presentation, intrahepatic cholangiocarcinoma is often multifocal (ie, satellites or intrahepatic metastases). Stijn Franssen, Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands, and colleagues aimed to compare the overall survival of patients with multifocal iCCA after HAIP floxuridine chemotherapy vs resection.
For the study, patients with histologically confirmed, multifocal iCCA were deemed eligible. The HAIP group consisted of consecutive patients from a single center who underwent HAIP floxuridine chemotherapy for unresectable multifocal iCCA between January 1, 2001, and December 31, 2018. The resection group consisted of consecutive patients from 12 centers who underwent a curative-intent resection for multifocal iCCA between January 1, 1990, and December 31, 2017.
Resectable metastatic disease to regional lymph nodes and previous systemic therapy was permitted. The exclusion was done for patients with distant metastatic disease (ie, stage IV), those who underwent resection before starting HAIP floxuridine chemotherapy, and those who received a liver transplant. Data analysis was done on September 1, 2021.
The Kaplan-Meier method and log-rank test were used to compare the overall survival in the 2 treatment groups.
The study included a total of 319 patients with multifocal iCCA were: 141 in the HAIP group (median [IQR] age, 62 years; 79 [56.0%] women) and 178 in the resection group (median age, 60 years; 91 [51.1%] men).
The study led to the following findings:
- The HAIP group was characterized by a higher percentage of bilobar disease (88.0% vs 34.3%), larger tumors (median, 8.4 cm vs 7.0 cm), and a higher proportion of patients with 4 or more lesions (66.7% vs 24.2%).
- Postoperative mortality after 30 days was 0.8% in the HAIP group vs 6.2% in the resection group.
- The median OS for HAIP was 20.3 months vs 18.9 months for resection.
- Five-year OS in patients with 2 or 3 lesions was 23.7% in the HAIP group vs 25.7% in the resection group.
- Five-year OS in patients with 4 or more lesions was 5.0% in the HAIP group vs 6.8% in the resection group.
- After adjustment for tumor diameter, the number of tumors, and lymph node metastases, the hazard ratio of HAIP vs resection was 0.75.
The researchers conclude, "patients with multifocal iCCA had similar OS after HAIP floxuridine chemotherapy vs resection."
"Careful consideration of resection of multifocal intrahepatic cholangiocarcinoma needs to be done given the complication rate of major liver resection; HAIP floxuridine chemotherapy may be an effective alternative option."
Reference:
Franssen S, Soares KC, Jolissaint JS, et al. Comparison of Hepatic Arterial Infusion Pump Chemotherapy vs Resection for Patients With Multifocal Intrahepatic Cholangiocarcinoma. JAMA Surg. Published online May 11, 2022. doi:10.1001/jamasurg.2022.1298
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