Gemcitabine-cisplatin safe, feasible as preoperative chemotherapy in cholangiocarcinoma

Gemcitabine plus cisplatin appears to be a safe and feasible preoperative treatment for patients with initially unresectable locally advanced or borderline resectable cholangiocarcinoma, suggests a study.

In this retrospective cohort, the investigators examined the potential of gemcitabine plus cisplatin chemotherapy as future preoperative therapy for patients with unresectable locally advanced or borderline resectable intrahepatic, perihilar, and midcholangiocarcinoma.

A total of 364 patients who presented at Amsterdam UMC between January 2016 and October 2019 were included in the analysis. Radiographic response after 3 and/or 6 cycles of gemcitabine-cisplatin chemotherapy was derived from the original radiologic reports and was then re-evaluated for surgical exploration by consensus reading of two hepato-pancreato-biliary surgeons and one radiologist.

Of the patients, 65 had a locally advanced or borderline resectable disease, and 28 were treated with palliative chemotherapy, including 25 (89.3 precent) patients who received more than 3 cycles.

Twenty-two (88.0 percent) and 13 patients (46.4 percent) demonstrated Response Evaluation Criteria in Solid Tumors (RECiST) stable disease or partial response after 3 and 6 cycles of chemotherapy, respectively. Grade 3 adverse events occurred in three patients.

In consensus reading, the investigators concluded that exploration could have been reconsidered in seven of 28 patients (25.0 percent).

“[T]he findings support rediscussion of patients with stable or responsive disease in multidisciplinary team meetings to reconsider resection,” the investigators said. “[P]rospective studies are needed to investigate this effect further and, based on these preliminary data, seem feasible in this setting.”