Chemotherapy with or without selective internal radiation therapy for intrahepatic cholangiocarcinoma: Data from clinical trials

Abstract

In advanced, liver-only intrahepatic cholangiocarcinoma (iCCA), Selective Internal Radiation Therapy (SIRT) has been suggested as promising in non-randomized studies. We aimed to compare data from patients with advanced, liver-only iCCA treated in first line in clinical trials with either chemotherapy alone or the combination with SIRT. We collected individual patients' data from the ABC-01, ABC-02, ABC-03, BINGO, AMEBICA and MISPHEC prospective trials. Data from patients with liver-only iCCA treated in chemotherapy-only arms of the first five trials were compared with data from patients treated with SIRT and chemotherapy in MISPHEC. Emulated target trial paradigm and Inverse Probability of Treatment Weighting (IPTW methods) using the propensity score were used to minimize biases. We compared 41 patients treated with the combination with 73 patients treated with chemotherapy alone, the main analysis being in 43 patients treated with cisplatin-gemcitabine or gemcitabine-oxaliplatin. After weighting, overall survival was significantly higher in patients treated with SIRT: median 21.7 months [95% Confidence Interval (CI): 14.1; not reached] vs 15.9 months [95%CI: 9.8; 18.9], Hazard Ratio = 0.59 [95%CI: 0.34; 0.99], p = 0.049. Progression-free survival was significantly improved: median 14.3 months [95%CI: 7.8; not reached] vs 8.4 months [95%CI: 5.9; 12.1], Hazard Ratio = 0.52 [95% CI: 0.31; 0.89], p < 0.001. Results were confirmed in most sensitivity analyses. Conclusion: This analysis derived from prospective clinical trials suggests that SIRT combined with chemotherapy might improve outcomes over chemotherapy alone in patients with advanced, liver-only iCCA. Randomized controlled evidence is needed to confirm these findings.