ADVERTISEMENT
Feasibility of gemcitabine plus cisplatin as neo-adjuvant in cholangiocarcinoma patients prior to liver transplantation
Background
The cholangiocarcinoma management is continually reviewed in the current evidence basis in order to develop practice guidelines and consensus statements. However, the standardized treatment guidelines are still unclear for cholangiocarcinoma patients who are listed for liver transplantation. We aimed to validate and evaluate the potential efficacy of chemotherapy combination of Gemcitabine and Cisplatin as a neo-adjuvant treatment for cholangiocarcinoma patients prior to liver transplantation.
Methods
In this prospective case series, patients with locally advanced, unresectable, hilar, or intrahepatic cholangiocarcinoma with no evidence of extrahepatic disease or vascular involvement were treated with a combination of Gemcitabine and Cisplatin as neo-adjuvant treatment with no radiation involved before being listed for liver transplantation at a single cancer center according to an open-labeled, the center-approved clinical management protocol. Patients were listed for liver transplantation if a minimum of six months of scans response or stability was confirmed. The primary endpoints were the overall survival and recurrence-free survival after liver transplantation. This report was an initial case series treated under this ongoing clinical treatment protocol, censored on March 17, 2022,.
Results
Between January 19, 2017, and March 17, 2022, out of 701 liver transplant recipients, only 10 patients (8 males and 2 females) with a median age of 62.71 [interquartile range (IQR): 60.02-71.87] were confirmed diagnosis of either intrahepatic or hilar cholangiocarcinoma. All of whom had undergone liver transplantation for intrahepatic or hilar cholangiocarcinoma. Median days for a given combination of Gemcitabine and Cisplatin as neo-adjuvant were 180.5 (IRQ: 120-250). Nine patients (90%) were reported with no recurrence or metastasis, only 1 patient confirmed metastasis (10%); days for metastasis after transplantation were 612 for this patient. All patients received a combination of Gemcitabine and Cisplatin as neo-adjuvant while awaiting liver transplantation. The median days of follow-up were 850.5 (IQR: 813-967). Overall survival was 100% (95% CI 100-100) at 1 year and 2 years, respectively. In the third year, the overall survival was 75% (95% CI: 12.8%-9%). 6.1One patient died at 885 days. No adverse events were reported after liver transplantation including the patient who was confirmed with recurrent.
Conclusions
Our finding demonstrated that Gemcitabine and Cisplatin as neo-adjuvant with no radiation involved have shown an excellent outcome for patients with intrahepatic or hilar cholangiocarcinoma prior to live transplantation.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
