Clinical feasibility of curative surgery after nab-paclitaxel plus gemcitabine-cisplatin chemotherapy in patients with locally advanced cholangiocarcinoma

• Published in: Surgery Vol. 173; no. 2; pp. 280 - 288
• Main Authors: Choi, Sung Hoon, Kang, Incheon, Lee, Sung Hwan, Kang, Beodeul, Cheon, Jaekyung, Kim, Dae Jung, Kim, Gwangil, Kwon, Chang-Il, Ko, Kwang Hyun, Chon, Hong Jae
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2023
• Subjects: Albumins; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bile Duct Neoplasms - drug therapy; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic - pathology; Cholangiocarcinoma - drug therapy; Cholangiocarcinoma - surgery; Cisplatin; Deoxycytidine; Feasibility Studies; Gemcitabine; Humans; Paclitaxel - therapeutic use; Pancreatic Neoplasms - surgery; Retrospective Studies
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2022.09.028

This study was conducted to evaluate the clinical feasibility of nab-paclitaxel plus gemcitabine-cisplatin triplet chemotherapy in patients with locally advanced cholangiocarcinoma in real-world practice. We retrospectively reviewed patients with locally advanced cholangiocarcinoma who were treated with nab-paclitaxel plus gemcitabine-cisplatin between October 2019 and August 2021 at a single institution. The initial diagnosis of cholangiocarcinoma was histologically confirmed. One hundred twenty-nine patients were included in this study. Among the patients with a measurable lesion (57.4%), the objective response rate and disease control were 60.8% and 91.9%, respectively. Seventy-seven patients (59.7%) were determined as resectable after triplet chemotherapy, but 73 (56.6%) underwent subsequent curative surgery. The major postoperative complication rate was 15.1%, and there were 2 postoperative mortalities (2.7%). There were 6 complete remission cases (8.2%) in the final pathology. The R0 resection was achieved in 67 patients (91.8%). Despite the initial locally advanced cholangiocarcinoma, a pathologic T stage of less than T2 was reported in 67 patients (91.8%). Fifty-two patients (71.2%) had no lymph node metastasis. Patients who underwent surgery after triplet chemotherapy had significantly higher 12-month overall survival (95.9% vs 76.8%; P < .001) than those treated with chemotherapy alone. Nab-paclitaxel plus gemcitabine-cisplatin chemotherapy demonstrated a down-staging effect through a high response rate, indicating that this triplet chemotherapy is feasible as induction therapy in patients with locally advanced cholangiocarcinoma. [Display omitted]