Data reported at the ASCO 2020 GI Cancers Symposium indicate that treatment with neoadjuvant definitive chemoradiation followed by orthotopic liver transplantation was associated with better outcomes compared with definitive chemoradiation alone in patients with unresectable extrahepatic/hilar CCA.
A study compared survival outcomes associated with neoadjuvant chemoradiation and orthotopic liver transplantation (OLT) versus definitive chemoradiation (CRT) in patients with unresectable extrahepatic/hilar CCA. The results of this study were presented at the American Society of Clinical Oncology (ASCO) 2020 Gastrointestinal Cancers Symposium and are summarized here.
Eligible patients had unresectable extrahepatic/hilar CCA who were treated with CRT with or without OLT at Mayo Clinic, Tucson, AZ, between February 1998 and September 2019. CRT consisted of external beam radiation therapy (EBRT; median, 4500 cGy) and boost (median, 900 cGy) with either continuous 5-fluorouracil (dose range, 180-225 mg/m2) or capecitabine (dose range, 825-1000 mg/m2 twice daily) alone or prior to undergoing OLT. Radiation boosts were delivered with EBRT or bile duct brachytherapy.
A total of 49 patients (OLT group, N = 20; CRT group, N = 29) were enrolled in the study. In the study population, the median age was 64.3 years at diagnosis (range, 27.9-84.3 years), and 18 patients had previous diagnosis of primary sclerosing cholangitis (PSC). In the OLT cohort, patients were younger (mean age, 56.5 vs 69.0 years), more likely to have PSC and ulcerative colitis (65% vs 17%), and had a lower cancer antigen 19-9 (median, 43 vs 535; P = .003).
At the end of follow-up, 31 of 49 (63%) patients had died, of which 7 (35%) were treated with neoadjuvant CRT and OLT therapy while 24 (86%) who were treated with definitive CRT died. From the end date of radiation, median OS was 76.8 months in the OLT group compared with 15.6 months in the CRT group. The 3-year OS and 5-year OS rates were significantly higher in the OLT group (78% and 69%, respectively) compared with the CRT group (19% and 6%, respectively; HR, 7.73; 95% CI, 3.04-19.65; P <.0001). Similarly, patients who received OLT showed a better 3-year PFS than CRT (89% vs 30%, respectively) and distant metastasis-free survival at 3 years (88% vs 66%, respectively) compared with those who received CRT alone (HR, 5.74; 95% CI, 1.12-29.34; P <.02). In univariate analysis, the method of treatment (OLT vs CRT) was found to be associated with better clinical outcomes.
These results support treatment with neoadjuvant CRT followed by OLT in patients with unresectable extrahepatic/hilar CCA compared with definitive CRT alone.
Source: Laughlin BS, et al. J Clin Oncol. 2020;38(4_suppl). Abstract 494.