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Nonsurgical Management of Cholangiocarcinoma

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Hepato-Pancreato-Biliary Malignancies

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Abstract

Cholangiocarcinoma arises from the biliary tract epithelium, comprising intrahepatic and extrahepatic cholangiocarcinomas. Surgical resection can be curative, but few patients are resectable at diagnosis, and the majority of patients who undergo surgery eventually recur, highlighting the significant unmet need to develop effective nonsurgical treatment.

For resected patients, adjuvant therapy can reduce the risk of disease recurrence and improve survival. Adjuvant capecitabine for 6 months is the standard of care, and patients with extrahepatic cholangiocarcinoma and a microscopically positive (R1) surgical margin may be offered chemotherapy with chemoradiation.

Patients with locally advanced, unresectable cholangiocarcinoma should undergo multimodality treatment to maximize the chances of downstaging to allow for eventual resection. Locoregional therapies, including radiotherapy and liver-directed therapy, are instrumental in this setting. Additional studies are underway to investigate how to best sequence or combine locoregional therapies with systemic therapies to optimize efficacy.

For patients with advanced or metastatic cholangiocarcinoma, chemotherapy with gemcitabine and cisplatin is the standard first-line systemic therapy. Genomic profiling studies in cholangiocarcinoma have revealed many actionable genomic alterations. Clinical trials with targeted therapies against IDH mutations, FGFR fusions/rearrangements, and BRAF V600E mutations have provided promising results. The role of immunotherapy in cholangiocarcinoma continues to evolve. For patients with mismatch repair deficient or microsatellite unstable (MMRd/MSI-H) tumors, checkpoint inhibitor therapy with a PD-1 inhibitor produces high response rates and durable responses. For patients without MMRd/MSI-H tumors, additional studies are needed to further identify predictive biomarkers and develop novel immunotherapy strategies to enhance anti-tumor immunity and maximize clinical responses.

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Authors and Affiliations

  1. Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

    Michael J. Breen & Chih-Yi Liao

  2. Section of Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA

    Osman S. Ahmed

  3. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Joshua Owen

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  1. Michael J. Breen
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  2. Osman S. Ahmed
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  3. Joshua Owen
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  4. Chih-Yi Liao
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Corresponding author

Correspondence to Chih-Yi Liao .

Editor information

Editors and Affiliations

  1. Medical Director, Capital Health Cancer Center, Director, CH Pancreas Center of Excellence, Director, CH Liver Center of Excellence, Pennington, NJ, USA

    Cataldo Doria

  2. Director of Interventional Gastroenterology, Capital Health Medical Center, Pennington, NJ, USA

    Jason N. Rogart

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Breen, M.J., Ahmed, O.S., Owen, J., Liao, CY. (2022). Nonsurgical Management of Cholangiocarcinoma. In: Doria, C., Rogart, J.N. (eds) Hepato-Pancreato-Biliary Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-41683-6_16

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  • DOI: https://doi.org/10.1007/978-3-030-41683-6_16

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