Session Name: Liver: Hepatocellular Carcinoma and Other Malignancies
Session Date & Time: None. Available on demand.
*Purpose: The standard treatment for hilar cholangiocarcinoma is using 5FU along with brachytherapy and external beam radiation. The downside of this regimen is the uncertain timing of radiation which makes the hilar dissection challenging. Gemcitabine and platinum-based therapy has emerged as a standard of care for cholangiocarcinoma. We looked into the pathological response to treatment using this regimen in our past 5 consecutive patients.
*Methods: A retrospective analysis of the 1) mode of diagnosis 2) duration of induction with gemcitabine and cisplatin 3) duration of maintenance treatment with either gemcitabine or with capecitabine and 4) pathological response to treatment in the explanted liver was made.
*Results: The five patients received gemcitabine-platinum and no external beam radiation. All patients maintained disease stability and underwent deceased donor liver transplantation based on the UNOS criteria for hilar cholangiocarcinoma. The patients had excellent pathological response to treatment.
*Conclusions: The availability of radiation free, gemcitabine/ platinum based protocol gives us an additional tool in the management of hilar cholangiocarcinoma. Single agent gemcitabine or capecitabine are safe to give for long term maintenance. If the long term outcomes parallels that of Mayo protocol, this may become the standard of care. This protocol may have higher surgeon acceptability because it offers a radiation free surgical field.
|Age / Sex||Primary Sclerosing Cholangitis (Y/N)||Mode of Diagnosis||Time from Dx to OLT||Induction||Radiation (Y/N)||Maintenance Chemo||Final Path|
|62 / M||Y||FISH||22 mo||4 Cycles Gem/Cis||N||Gem 16 mo||ypT0N0|
|72 / F||N||Biopsy with adenoCa||21 mo||9 Cycles Gem/Oxali||Y (Brachy)||Cape 7 mo||ypT1N0|
|74 / M||Y||FISH||12 mo||6 Cycles Gem/ Cis||N||Gem 3 mo||ypT0N0|
|61 / M||Y||FISH||12 mo||6 Cycles Gem/Cis||N||Gem 4 mo||ypT0N0|
|64 / M||N||Brushings with adenoCa||5 mo||4 Cycles Gem/Cis||N||Gem 2 mo||ypT2N0|
To cite this abstract in AMA style:Saharia A, McMillan R, Kodali S, Javley M, Mobley CM, Hobeika MJ, Shetty A, Victor DW, McFadden R, Abdelrahim M, Heyne K, Gaber AO, Ghobrial RM. Excellent Pathological Response with Gemcitabine-based Protocol in Patient with Hilar Cholangiocarcinoma [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/excellent-pathological-response-with-gemcitabine-based-protocol-in-patient-with-hilar-cholangiocarcinoma/. Accessed June 18, 2021.
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