Liver Transplantation for Locally Advanced Intrahepatic Cholangiocarcinoma Treated with Neoadjuvant Therapy: A Pilot Cohort Study
1Houston Methodist Hospital, Houston, TX
2MD Anderson Cancer Center, Houston, TX.
Meeting: 2018 American Transplant Congress
Abstract number: B269
Keywords: Liver transplantation, Malignancy, Outcome, Survival
Session Information
Session Name: Poster Session B: Liver: Hepatocellular Carcinoma and Other Malignancies
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
INTRODUCTION
Intrahepatic cholangiocarcinoma (iCCA) is a well-recognized contraindication for liver transplantation (LT). Recent reports indicate favorable LT outcomes for early iCCA (<2cm), but, poor survival persists for advanced iCCA. Given that effects of neoadjuvant therapy on LT for iCCA have not been established, this study prospectively evaluated efficacy of neoadjuvant therapy on LT outcomes for iCCA.
METHODS
Per Methodist-MD Anderson Joint Cholangiocarcinoma Collaborative protocol, pts without extrahepatic disease or vascular involvement underwent neoadjuvant therapy with a gemcitabine/cisplatin-based regimen and demonstrated a minimum of 6 mo of prior to LT.
RESULTS
From 2010-2017, 6 pts iCCA met inclusion criteria underwent LT. Median time from diagnosis to LT was 22mo. All pts received chemotherapy, and two received radiation. Median follow-up was 37mo (24-73mo). Explant tumor characteristics are shown in Table 1. Median iCCA cumulative diameter was 14.2cm, largest lesion was 5.9 cm, and 5/6 had multifocal disease. One pt died at 14 months post-LT due to recurrence, with overall survival of 100%, 83%, and 83% at 1-, 3- and 5yrs. Three pts developed recurrence a median of 7.1mo after LT, with recurrence free survival of 83%, 50%, and 50% at 1-, 3- and 5yrs. There were no discernable associations of recurrence with grade, stage, perineural, or lymphovascular invasion. Mutations in FGFR2 and SPTA1 were most common but did not associate with recurrence.
|
Characteristic |
Median (Range) or N (%) |
| Number of lesions | 7 (1-10) |
| Maximum size largest lesion (cm) | 5.9 (3.5-10.5) |
| Cumulative Diameter (cm) | 14.2 (5.2-20) |
| Bilobar Location | 4 (67%) |
| Poorly Differentiated Grade | 3 (50%) |
| Lymphovascular Invasion | 2 (33%) |
| Perineural Invasion | 1 (17%) |
| Positive Margins | 1 (17%) |
DISCUSSION
Chemosensitivity and sustained response to neoadjuvant therapy may represent reasonable selection criteria for LT for iCCA. Tumor biology rather than size may dictate recurrence for iCCA following LT in the setting of neoadjuvant therapy. Further study is necessary to determine correlation with specific genetic mutations. A larger scale prospective trial is necessary to consider iCCA as an accepted indication for LT.
CITATION INFORMATION: Lunsford K., Javle M., Heyne K., Shroff R., Hassan Ali R., Mobley C., Victor D., Kaseb A., Aloia T., Conrad C., Li X., Monsour H., Gaber A., Vauthey J-.N., Ghobrial R. Liver Transplantation for Locally Advanced Intrahepatic Cholangiocarcinoma Treated with Neoadjuvant Therapy: A Pilot Cohort Study Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Lunsford K, Javle M, Heyne K, Shroff R, Ali RHassan, Mobley C, Victor D, Kaseb A, Aloia T, Conrad C, Li X, Monsour H, Gaber A, Vauthey J-N, Ghobrial R. Liver Transplantation for Locally Advanced Intrahepatic Cholangiocarcinoma Treated with Neoadjuvant Therapy: A Pilot Cohort Study [abstract]. https://atcmeetingabstracts.com/abstract/liver-transplantation-for-locally-advanced-intrahepatic-cholangiocarcinoma-treated-with-neoadjuvant-therapy-a-pilot-cohort-study/. Accessed November 21, 2024.« Back to 2018 American Transplant Congress