Intrahepatic Cholangiocarcinoma

Significant response to transarterial chemoembolization combined with PD-1 inhibitor and apatinib for advanced intrahepatic cholangiocarcinoma: A case report and literature review

Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignancy rising from the biliary tree with poor prognosis. We report the feasibility and efficacy of transarterial chemoembolization (TACE) combined with PD-1 inhibitor and apatinib for the treatment of a patient with unresectable ICC. A 70-year-old female presented with intermittent right upper abdominal distension, abdominal pain, and vomiting after eating for more than one month. Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed multiple intrahepatic lesions, retroperitoneal lymph node, and left lung metastasis. Based on the patient's medical history and pathology, the diagnosis was confirmed as locally advanced unresectable ICC. Multimodal therapy was applied to the ICC. The therapy comprised TACE every three months, and a combination regimen of the PD-1 inhibitor camrelizumab and the antiangiogenic agent apatinib. The patient underwent microwave ablation for a lesion on the left lung that had not responded to systemic therapies. Enhanced CT scan after every 2-3 months was performed. After several sessions, the primary lesion reduced dramatically in size. At 20 months from diagnosis, the patient was alive, in good condition, and stable. The patient experienced no critical complications and toxicity associated with the administered therapies. This case suggests that treatment with TACE combined with systemic therapy of camrelizumab combined with apatinib may be a safe and effective treatment option for patients with inoperable ICC.

Contrast-enhanced Ultrasound Features of Intrahepatic Cholangiocarcinoma: A New Perspective

The objective of this study was to illustrate our specific findings for intrahepatic cholangiocarcinoma (ICC) lesions on contrast-enhanced ultrasound (CEUS). In this study, 21 patients at our hospitals with pathologically proven ICC and CEUS data were retrospectively enrolled. General clinical data of the patients, and features of lesions on conventional and contrast-enhanced ultrasound were recorded. Two experienced radiologists retrospectively reviewed all images by consensus. On gray-scale sonography, hypoechoic, isoechoic and hyperechoic lesions accounted for 85.7%, 9.5% and 4.8%, respectively, of all lesions. Hypovascular patterns were found for 95.2% of the lesions on color Doppler flow imaging. During the arterial phase of CEUS, heterogeneous hyperenhancement, homogeneous hyperenhancement, rim-like hyperenhancement, isoenhancement and hypoenhancement were observed for 61.9%, 19.0%, 9.5%, 4.8%, 4.8% of the lesions, respectively. During the portal venous and late phases, 85.7% and 95.2% of the lesions, respectively, exhibited hypoenhancement. In addition, 66.7% of the ICC lesions exhibited washed-out interiors but little decrease in enhancement at the periphery during the portal venous phase, resulting in the formation of a hyperenhanced peripheral rim. In conclusion, the rim sign in the portal venous phase of CEUS could help diagnose ICC. This trait could be related to the infiltrating growth pattern of ICC.

Ablation of Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma is the second most common primary liver cancer but represents only a small portion of all primary liver cancers. At the time of diagnosis, patients are often not surgical candidates due to tumor burden of other comorbidities. In addition, there is a very high rate of tumor recurrence after resection. Local regional therapies, specifically ablative therapies of radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation, have proven to be beneficial with other hepatic tumors. The purpose of this review is to provide an overview and update of the medical literature demonstrating ablative therapy as a treatment option for intrahepatic cholangiocarcinoma.

Liver-Directed Therapies for Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) are primary liver cancers where all or most of the tumor burden is usually confined to the liver. Therefore, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease with minimal systemic side effects. The English medical literature and clinical trials were reviewed to provide a synopsis on the available liver-directed percutaneous therapies for HCC and IHC. Locoregional liver-directed therapies provide survival benefit for patients with HCC and IHC compared to best medical treatment and have lower comorbid risks compared to surgical resection. These treatment options should be considered, especially in patients with unresectable disease.

Both plasma and tumor tissue miR-146a high expression correlates with prolonged overall survival of surgical patients with intrahepatic cholangiocarcinoma

The purpose of this study was to investigate the association of tumor tissue and plasma miR-146a/b expressions with the clinicopathological properties and overall survival (OS) in surgical patients with intrahepatic cholangiocarcinomas (ICC).Eighty-seven patients with ICC were enrolled. Tumor tissue and plasma sample were collected and miR-146a/b expressions were assessed by quantitative polymerase chain reaction (qPCR). The median follow-up duration was 31 months, and the last follow-up date was January 2017.miR-146a (P < .001) and miR-146b (P = .006) expressions in tumor tissue were positively associated with that in plasma. Tissue miR-146a was negatively correlated with age (P = .036), poor differentiation (P = .020), N stage (P = .020), and TNM stage (P = .007), as well as ECOG performance (P = .008), whereas plasma miR-146a was inversely associated with N stage (P = .003), TNM stage (P = .003), and ECOG performance (P = .011). Moreover, tissue miR-146b was negatively correlated with gender (P = .043) and T stage (P = .047). Kaplan-Meier curves suggested that high expression of tissue miR-146a (P < .001) and plasma miR-146a (P = .029) were correlated with prolonged OS. Nevertheless, no association of miR-146b expression in tumor tissue (P = .187) and plasma (P = .336) with OS was discovered. Univariate analysis indicated that both tissue miR-146a (P < .001) and plasma miR-146a (P = .035) could predict better OS, whereas multivariate analysis revealed that only tissue miR-146a (P = .001) high expression was an independent factor for prolonged OS.Both plasma and tissue miR-146a expression correlated with favorable OS, whereas only tissue miR-146a was an independent prognostic biomarker in surgical patients with ICC.

The role of interventional radiology in the treatment of intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy after hepatocellular carcinoma. Complete surgical resection remains the only potentially curative option for patients with ICC. However, until now, early diagnosis with potential surgical intervention has been the exception rather than the rule with only 30% of patients qualifying for attempted surgical cure. Many patients are unresectable because of disease stage, anatomic conditions, medical comorbidities, and small future remnant liver. Interventional radiology procedures are available for these types of patients with intra-arterial therapies and/or ablative treatments both for curative and for palliative treatment. The goals of interventional therapy are to control local tumor growth, to relieve symptoms, and to improve and preserve quality of life. The choice of treatment depends largely on tumor extent and patient performance. No randomized studies exist to compare treatments. The present review describes the current evidence of the interventional treatments in the management of the ICC. Moreover, interventional procedures available to increase the future liver reserve before surgery were analyzed.

Locoregional Therapies of Cholangiocarcinoma

BACKGROUND

Cholangiocarcinoma (CC) is the second most primary liver malignancy with increasing incidence in Western countries. Currently, surgical R0 resection is regarded as the only potentially curative treatment. The results of systemic chemotherapy and best supportive care (BSC) in patients with metastatic disease are often disappointing in regard to toxicity, oncologic efficacy, and overall survival. In current practice, the use of different locoregional therapies is increasingly more accepted.

METHODS

A review of the literature on locoregional therapies for intrahepatic cholangiocarcinoma (ICC) was undertaken.

RESULTS

There are no prospective randomized controlled trials. For localized ICC, either primary or recurrent, radiofrequency ablation (RFA) is by far the most commonly used thermal ablation modality. Thereby, a systematic review and meta-analysis reports major complication in 3.8% as well as 1-, 3-, and 5-year overall survival rates of 82, 47, and 24%, respectively. In selected patients (e.g. with a tumor diameter of ≤3 cm), oncologic efficacy and survival after RFA are comparable with surgical resection. For diffuse ICC, different transarterial therapies, either chemotherapy-based (hepatic artery infusion (HAI), transarterial chemoembolization (TACE)) or radiotherapy-based (transarterial radioembolization (TARE)), show extremely promising results. With regard to controlled trials (transarterial therapy versus systemic chemotherapy, BSC or no treatment), tumor control is virtually always better for transarterial therapies and very often accompanied by a dramatic survival benefit and improvement of quality of life. Of note, the latter is the case not only for patients without extrahepatic metastatic disease but also for those with liver-dominant extrahepatic metastatic disease. There are other locoregional therapies such as microwave ablation, irreversible electroporation, and chemosaturation; however, the current data support their use only in controlled trials or as last-line therapy.

CONCLUSION

Dedicated locoregional therapies are commonly used for primary and recurrent ICC as well as liver-only and liver-dominant extrahepatic metastatic disease. Currently, the best evidence and most promising results are available for RFA, HAI, TACE, and TARE. In cohort studies, the overall survival rates are similar to those obtained with surgery or systemic therapies. Prospective randomized controlled trials are warranted to compare safety and efficacy between different surgical, interventional, and systemic therapies, as well as their combinations.