NEW YORK (Reuters Health) - In patients with multifocal intrahepatic cholangiocarcinoma (iCCA), hepatic arterial infusion pump (HAIP) floxuridine chemotherapy may be an effective alternative to surgery, a cohort study suggests.
"We believe that these findings are practice-changing," Stijn Franssen and Dr. Bas Groot Koerkamp, both of Erasmus MC Cancer Institute in Rotterdam, told Reuters Health by email. "In the current guidelines, first-line treatment for multifocal iCCA is palliative systemic chemotherapy alone, with no patients surviving beyond three years. Based on the results of this study, we recommend systemic chemotherapy combined with HAIP chemotherapy with floxuridine as first-line treatment."
"Alternatively," they said, "HAIP chemotherapy with floxuridine can be offered as second-line treatment after prior systemic chemotherapy," they said. "With this treatment, about a third of patients will survive beyond three years. Selected fit patients have similar outcomes after surgical resection, but at a higher initial risk of postoperative mortality."
As reported in JAMA Surgery, the two researchers and their colleagues compared overall survival (OS) of multifocal iCCA patients after HAIP floxuridine chemotherapy (141 patients; median age, 62; 56%, women) versus resection (178 patients; median age, 60; 51%, men).
HAIP patients had a higher percentage of bilobar disease (88% vs. 34.3%); larger tumors (median, 8.4 cm vs. 7.0 cm); and a higher proportion of patients with four or more lesions (66.7% vs. 24.2%).
