Systemic Treatments with Tyrosine Kinase Inhibitor and Platinum-Based Chemotherapy in Patients with Unresectable or Metastatic Hepatocholangiocarcinoma

Title	Systemic Treatments with Tyrosine Kinase Inhibitor and Platinum-Based Chemotherapy in Patients with Unresectable or Metastatic Hepatocholangiocarcinoma
Authors	Elia Gigante, Christian Hobeika, Brigitte Le Bail, Valérie Paradis, David Tougeron, Marie Lequoy, Mohamed Bouattour, Jean-Frederic Blanc, Nathalie Ganne-Carrié, Henri Tran, Clémence Hollande, Manon Allaire, Giuliana Amaddeo, Hélène Regnault, Paul Vigneron, Maxime Ronot, Laure Elkrief, Gontran Verset, Eric Trepo, Aziz Zaanan, Marianne Ziol, Massih Ningarhari, Julien Calderaro, Julien Edeline, Jean-Charles Nault
Magazine	Liver Cancer
Date	06/14/2022
DOI	10.1159/000525488
Introduction	Although no systemic treatment is officially approved for unresectable hepatocellular-cholangiocarcinoma (cHCC-CCA), tyrosine kinase inhibitors (TKIs) and platinum-based chemotherapy are commonly employed in clinical settings. This research seeks to evaluate the effectiveness of first-line systemic treatments in cHCC-CCA patients. Patients with a histological diagnosis of unresectable or metastatic cHCC-CCA, confirmed by a centralised review (WHO classification 2019), and who received systemic treatments between 2009 and 2020 were retrospectively included from 11 centres. Outcomes for cHCC-CCA patients were compared to those with hepatocellular carcinoma (HCC) treated with sorafenib and intrahepatic cholangiocarcinoma (iCCA) treated primarily with platinum-based chemotherapy using a frailty Cox model. The study assessed the efficacy of TKIs and platinum-based chemotherapies in cHCC-CCA patients using a reliable estimator. Results showed that 83 cHCC-CCA patients were included, predominantly male with underlying cirrhosis, extrahepatic metastases, and macrovascular tumour invasion. cHCC-CCAs were more commonly associated with cirrhosis than iCCA but less so than HCC. Extrahepatic metastases were less frequent in HCC and cHCC-CCA than in iCCA. Unadjusted overall survival (OS) was better in iCCA compared to cHCC-CCA and HCC. Multivariable analysis using a Cox frailty model showed similar survival for cHCC-CCA, HCC, and iCCA. Factors such as ALBI score, ascites, and tobacco use were independently associated with OS in cHCC-CCA patients. Among these patients, those treated with TKI had a median OS of 8.3 months compared to 11.9 months for those treated with platinum-based chemotherapy. After adjusting for tumour characteristics, treatment type did not significantly impact OS or progression-free survival. In conclusion, first-line systemic treatments with TKIs or platinum-based chemotherapies exhibit comparable efficacy in unresectable/metastatic cHCC-CCA patients. The ALBI score is a predictor of OS.
Quote	Elia Gigante, Christian Hobeika and Brigitte Le Bail et al. Systemic Treatments with Tyrosine Kinase Inhibitor and Platinum-Based Chemotherapy in Patients with Unresectable or Metastatic Hepatocholangiocarcinoma. Liver Cancer. 2022. Vol. 11(5):460-473. DOI: 10.1159/000525488
Industry	Pharmaceutical Industry