52: Adjuvant chemotherapy for resected intrahepatic cholangiocarcinoma confers no survival advantage.

Saturday, March 25, 2023

10:56 AM – 11:06 AM

Location: Ballroom A

Abstract Presenter(s)

Jeremy Sharib, MD (he/him/his)

Assistant Professor
University of Washington, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Jeremy Sharib, MD (he/him/his)

Assistant Professor
University of Washington, United States

Disclosure(s): No financial relationships to disclose

Author(s)

AL

Annie Liu, MD PhD

Resident
Duke University Medical Center
Durham, North Carolina, United States

Disclosure information not submitted.
SM

Sarah McIntyre, MD

Resident
New York University, United States

Disclosure information not submitted.
Kristen E. Rhodin, MD

General Surgery Resident
Duke University Medical Center
Durham, North Carolina, United States

Disclosure(s): No financial relationships to disclose
NK

Nancy E. Kemeny, MD

Attending
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
AC

Andrea Cercek, MD

Associate Attending
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
JH

James J. Harding, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Ghassan Abou-Alfa, MD, MBA

Professor
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
KS

Kevin C. Soares, MD

Hepatobiliary Surgeon
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Alice C. Wei, MD MSc FRCSC FACS (she/her/hers)

Associate Attending Surgeon
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
JD

Jeffrey A. Drebin, MD, PhD

Chair, Department of Surgery; Murray F. Brennan Chair in Surgery
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
TK

T. Peter Kingham, MD

Director of Global Cancer Disparities Initiatives
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
MD

Michael I. D’Angelica, MD

Enid A. Haupt Chair in Surgery
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
HU

Hope Uronis, MD, MHS

Associate Professor of Medicine
Duke University Medical Center, United States

Disclosure information not submitted.
JS

John H. Strickler, MD

Associate Professor of Medicine
Duke University Medical Center, United States

Disclosure information not submitted.
MM

Michael A. Morse, MD

Professor of Medicine
Duke University Medical Center, United States

Disclosure information not submitted.
Sabino Zani, Jr., MD

Associate Professor of Surgery
Duke University Medical Center
Durham, North Carolina, United States

Disclosure information not submitted.
Peter Allen, MD

chief, surgical oncology
Duke University Medical Center
Durham, NC, United States

Disclosure information not submitted.
WJ

William R. Jarnagin, MD

Chief, Hepatobiliary Service; Leslie Blumgart Chair in Surgery
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Michael E. Lidsky, MD

Assistant Professor of Surgery
Duke University
Durham, North Carolina, United States

Disclosure information not submitted.

Disclosure(s):

Jeremy Sharib, MD: No financial relationships to disclose

Kristen E. Rhodin, MD: No financial relationships to disclose

Introduction: Randomized data suggest improved survival with adjuvant chemotherapy for biliary tract cancers, but subset analyses of intrahepatic cholangiocarcinoma (ICC) show limited survival benefit. This study uses a large bi-institutional cohort of resected ICC patients to evaluate the impact of adjuvant therapy on recurrence patterns and overall survival (OS) and compares these findings to data from a national cancer registry.

Methods: Patients with resected ICC were identified within a bi-institutional cohort (Duke and Memorial Sloan Kettering, 1997-2020) and the National Cancer Database (NCDB, 2010-2018). Patients were stratified by treatment with adjuvant chemotherapy (adj). Site of first recurrence was categorized as local (liver only), regional (liver and perihepatic nodes), nodal (perihepatic nodes only), distant, or mixed (both liver and distant). OS was compared with Kaplan-Meier methods.

Results: 367 patients underwent resection for ICC, and 163 (44%) patients received adjuvant therapy. Median follow-up was 33 vs. 44 months (adj vs observation (obs), p=0.15). 263 (72%) patients had recurrent disease, most commonly in the liver (72%). There was no difference in recurrence patterns stratified by treatment with adjuvant chemotherapy (% recurrence, adj vs obs; local: 42 vs 42; regional: 2 vs 2; nodal: 0 vs 3; distant only: 27 vs 26; mixed: 29 vs 27, p=0.5). OS was the same between groups (adj vs obs; 42 vs 49 months, p=0.3) and when stratified by recurrence site (p=0.5). Similarly, in an NCDB cohort of 1,159 ICC patients over the same time period, there was no association between adjuvant therapy and OS (adj vs obs; 49 vs 57 months, p=0.1)

Conclusions: In this retrospective dual registry analysis, corroborated by national data, adjuvant chemotherapy was not associated with an improvement in OS in ICC patients subjected to curative intent resection. Further, adjuvant therapy had no impact on the high rate of hepatic recurrence, suggesting that alternative strategies, such as liver directed therapies, are needed to improve recurrence rates and OS.

Learning Objectives:

Describe the prior studies that informed use of adjuvant chemotherapy for biliary tract cancers.
Evaluate survival patterns for patients following resection of intrahepatic cholangiocarcinoma.
Describe recurrence patterns of intrahepatic cholangiocarcinoma following surgical resection.