AMMF’s Virtual 2021 European Cholangiocarcinoma Conference

Abstract No 15

Systematic review and pooled analysis of locoregional therapies in patients with intrahepatic cholangiocarcinoma

Julien Edeline¹, Angela Lamarca², Mairéad G McNamara³, Timothy Jacobs⁴, Richard A Hubner², Dan Palmer⁵, Bas Groot Koerkamp⁶, Philip Johnson⁵, Boris Guiu⁷ and Juan W Valle³

¹Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
²Department of Medical Oncology, The Christie NHS Foundation, Manchester; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
³Division of Cancer Sciences, University of Manchester/Department of Medical Oncology, Manchester, United Kingdom
⁴The Library, The Christie NHS Foundation Trust, Manchester, United Kingdom
⁵University of Liverpool, Liverpool, United Kingdom
⁶Hepatobiliary Surgery, Erasmus MC, Rotterdam, Netherlands
⁷Department of Radiology, St-Eloi University Hospital, Montpellier, France

Background

Locoregional treatments (LRT) including radioembolisation (SIRT), transarterial chemo-embolisation (TACE), hepatic arterial infusion (HAI) of chemotherapy, external beam radiotherapy (EBRT) and ablation, have been studied for the management of intrahepatic cholangiocarcinoma (iCC). The aim of this systematic review was to provide outcome benchmarks for clinical trial design.

Methods

Identification of studies reporting outcomes of patients treated with LRT for iCC was performed using PubMed and Embase. Pooled weighted means were calculated for progression-free survival (PFS) and overall survival (OS); meta-analysis of proportions was used for estimation of pooled response rate.

Results

6325 entries were reviewed; 93 studies were eligible, representing 101 cohorts and a total of 3990 patients [15 cohorts (645 patients) for ablation, 18 cohorts (541 patients) for EBRT, 27 cohorts (1232 patients) for SIRT, 22 cohorts (1145 patients) for TACE, 16 cohorts (331 patients) for HAI and 3 cohorts (96 patients) not pooled]. 74% of the studies were retrospective, 93% non-randomised; and 19% were only available in abstract form.

The pooled mean weighted OS was 30.2 months (95% confidence interval (CI): 21.8-38.6) for ablation, 18.9 (14.2-23.5) for EBRT, 14.1 (12.1-16.0) for SIRT, 15.9 (12.9-19.0) for TACE and 21.3 (15.4-27.1) for HAI. The pooled complete response rate was 93.9% for ablation. When analysed together, SIRT, TACE and HAI had a pooled mean weighted OS of 15.7 months (all patients) and 25.2 months for patients treated in first-line with concomitant systemic chemotherapy.

Conclusions

Available literature on LRT for iCC was heterogeneous and of insufficient quality to make strong recommendations. Ablation achieved satisfactory outcomes, and may be recommended when surgery is not feasible. Benchmark outcome estimates are provided to inform the design of phase III trials.

Keywords

Yttrium-90; intra-arterial therapies; biliary tract cancer; interventional radiology; interventional oncology; radiation oncology

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