Hepatic Arterial Infusion Pump Floxuridine Chemotherapy vs Resection for Intrahepatic Cholangiocarcinoma

Hepatic arterial infusion pump (HAIP) floxuridine chemotherapy yielded similar overall survival (OS) as resection in patients with multifocal intrahepatic cholangiocarcinoma and may be an effective alternative treatment option, according to an analysis published in JAMA Network Surgery.

Stijn Franssen, MD, Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands, and colleagues conducted this cohort study to evaluate the efficacy of HAIP floxuridine chemotherapy as an alternative treatment to resection in patients with multifocal intrahepatic cholangiocarcinoma.

The HAIP group (n = 141) contained consecutive patients from a single center who underwent HAIP floxuridine chemotherapy for unresectable multifocal intrahepatic cholangiocarcinoma between January 1, 2001, and December 31, 2018. The resection group (n = 178) contained consecutive patients from 12 centers who underwent a curative-intent resection for multifocal intrahepatic cholangiocarcinoma between January 1, 1990, and December 31, 2017.

A total of 319 patients were included in the study. The HAIP group was characterized by a higher percentage of bilobar disease (88% [n = 124] vs 34.3% [n = 61]), larger tumors (median, 8.4 cm vs 7 cm), and a higher proportion of patients with ≥ 4 lesions (66.7% [94] vs 24.2% [43]).

After 30 days, the postoperative mortality was 0.8% (95% CI, 0% to 2.1%) in the HAIP group vs 6.2% (95% CI, 2.3% to 9.7%) in the resection group (P = .01). Median OS was 20.3 months vs 18.9 months, respectively (P = .32).

In patients with 2 or 3 lesions, the 5-year OS was 23.7% (95% CI, 12.3% to 45.7%) in the HAIP group vs 25.7% (95% CI, 17.9% to 37.0%) in the resection group. The hazard ratio after adjusting for tumor diameter, number of tumors, and lymph node metastases, for HAIP floxuridine chemotherapy vs resection was 0.75 (95% CI, 0.55 to 1.03; P = .07).

“This cohort study found that patients with multifocal [intrahepatic cholangiocarcinoma] had similar OS after HAIP floxuridine chemotherapy vs resection,” concluded Dr Franssen and colleagues.

“Resection of multifocal intrahepatic cholangiocarcinoma needs to be considered carefully given the complication rate of major liver resection; HAIP floxuridine chemotherapy may be an effective alternative option,” they added.

Source:

Franssen S, Soares KC, Jolissaint JS, et al. Comparison of Hepatic Arterial Infusion Pump Chemotherapy vs Resection for Patients With Multifocal Intrahepatic Cholangiocarcinoma. JAMA Surg. Published online May 11, 2022. doi:10.1001/jamasurg.2022.1298.