FOLFOX Delivery Method Could Offer Option in Unresectable Intrahepatic Cholangiocarcinoma

For patients whose intrahepatic cholangiocarcinoma (ICC) cannot be treated with surgery, delivery of a well-known chemotherapy combination through transarterial infusion (TIA) could offer an option with limited adverse events (AEs), according to results in Journal of Oncology.

Investigators from Sun Yat-Sen University Cancer Center in Guangzhou, China, report that use of TIA to deliver FOLFOX (folinic acid, fluorouracil, and oxaliplatin) in 29 patients with ICC yielded an overall response rate (ORR) of 37%, with median progression-free survival (PFS) of 8.7 months and median overall survival (OS) of 16.2 months.

Benefits of TIA, in which a high concentration of the therapy or combination is injected through the hepatic artery, include the “milder inflammatory reactions” compared with other strategies, as well as the reduced chance of bile duct injury, which the authors said, “have been reported as the main causes of death in patients with ICC.”

ICC is still comparatively rare, but incidence has been climbing worldwide. Although there has been progress in developing targeted therapies for this condition, outcomes have been dismal for patients whose tumors cannot be treated with surgery. Many studies in ICC involve trying treatment options that have worked for disease types, such as liver and pancreatic cancers. The investigators in this study pursued TIA after its success in treating intermediate and advanced hepatocellular carcinoma.

This was a retrospective study of patients not previously treated for ICC or other cancer and not eligible for surgery. Among other criteria, the patients could not have impaired function of major organs, such as the heart, lung, brain, kidney, or liver. Patients were treated with a catheter or microcatheter rather than a port. TAI was performed once every 3 to 4 weeks. The primary end point was OS, with the initial follow-up visit after the second treatment cycle.

Median follow-up was 11.6 (range, 3.1-27.0) months. Of the original group, 27 patients had evaluable efficacy, including 15 patients (51.7%) who died. Median OS was 16.2 (95% CI, 13.0-19.4) months, and 19 patients (65.5%) had disease progression, with a median PFS of 8.7 (95% CI, 6.2-11.1) months. No patients had a complete response, 10 had a partial response, 13 had stable disease (SD), and 4 had progressive disease. The disease control rate, defined as the ORR plus patients with SD, was 85.2%. In the safety analysis, 93.1% of patients had AEs of grade 1/2, and 1 patient had a grade 3 event.

These results, the authors write, make TIA with FOLFOX a “perfect option for the multiagent management of ICC,” which may later be treated with targeted therapy, immunotherapy, and radiotherapy.

The study was limited by its small size.

“In conclusion,” the authors wrote, “the present study demonstrated that TIA with the FOLFOX regimen could be an effective and safe treatment for unresectable ICC. However, the results need to be further confirmed through large-scale prospective randomized clinical trials in the future.”

Reference

Li S, Deng M, Wang Q, et al. Transarterial infusion chemotherapy with FOLFOX could be an effective and safe treatment for unresectable intrahepatic cholangiocarcinoma. J Oncol. Published March 15, 2022. doi:10.1155/2022/2724476