Page 130 - Read Online

An et al. Hepatoma Res 2023;9:43 https://dx.doi.org/10.20517/2394-5079.2023.60 Page 7 of 12

Table 2. Prior studies investigating TACE in treatment of intrahepatic cholangiocarcinoma
Author Study type Sample size Technique Outcomes
Burger et al. (2005) [50] Retrospective n = 17 cTACE Median OS = 23 months
[48]
Vogl et al. (2012) Retrospective n = 115 cTACE Median OS = 13 months
[40]
Mosconi et al. (2021) Meta-analysis n = 906 cTACE and DEB-TACE Median OS = 14.2 months
[54]
Aliberti et al. (2008) Prospective n = 11 DEB-TACE Median OS = 13 months
[55]
Liu et al. (2022) Retrospective n = 39 DEB-TACE Median PFS = 8.0 months
Median OS = 11.0 months
[56]
Zhou et al. (2020) Retrospective n = 88 DEB-TACE Median PFS = 3.0 months Median OS = 9.0 months
TACE: trans-arterial chemoembolization; cTACE: conventional TACE; DEB-TACE: drug-eluting bead TACE.

survival benefits for patients with unresectable intrahepatic cholangiocarcinoma.

TACE combined with chemotherapy
Multiple retrospective studies have demonstrated survival benefits for TACE in combination with palliative
chemotherapy [53,66] . A study by Gairing et al. demonstrated improved median overall survival in patients
receiving gemcitabine/cisplatin combined with TACE compared to palliative chemotherapy alone (26.2 vs.
13.1 months) . Kiefer et al. similarly reported improved survival in patients who received both systemic
[66]
[43]
chemotherapy and TACE compared to those who received TACE alone (28 months vs. 16 months) .
These findings have been further supported in a prospective, phase II study by Martin et al. in patients
randomized to gemcitabine/cisplatin with DEB-TACE (irinotecan) vs. gemcitabine/cisplatin alone . In this
[67]
study with 48 patients, the overall response rate was significantly greater in the chemotherapy with DEB-
TACE group compared to the chemotherapy alone group at 2, 4, and 6 months. In addition, there was
improved overall survival in the combined DEB-TACE with systemic chemotherapy group compared to
systemic chemotherapy alone (33.7 vs. 12.6 months). An added benefit of the combined DEB-TACE and
chemotherapy group was an increased rate of downsizing of tumor to resection or curative ablation
compared to the chemotherapy alone group. There are currently no phase 3, randomized controlled clinical
trials assessing the clinical efficacy of TACE in combination with systemic chemotherapy.

TARE combined with chemotherapy
Prior studies have also demonstrated a survival benefit for TARE in combination with systemic
chemotherapy for intrahepatic cholangiocarcinoma. A meta-analysis performed by Cucchetti et al. analyzed
224 patients from nine retrospective studies and demonstrated improved median survival in patients who
underwent SIRT with concomitant chemotherapy (19.5 months) compared to those not receiving
chemotherapy (5.5 months) . This meta-regression study also found that SIRT was most likely to be
[68]
beneficial in mass-forming CCA. An additional study retrospectively studied 24 patients who underwent
SIRT with chemotherapy given either prior to SIRT or concomitantly with SIRT. This study demonstrated
longer progression-free survival when chemotherapy was given concomitantly with SIRT compared to
[69]
before SIRT (20.0 vs. 8.8 months) .
These findings were further supported in a prospective, phase 2 clinical trial by Edeline et al. in which SIRT
[70]
was performed concomitantly with first-line gemcitabine/cisplatin . The overall response rate was 39% at 3
months based on RECIST criteria, with a disease control rate of 98%. Median overall survival was also noted
to be 22 months, which was favorable compared to historical controls receiving palliative chemotherapy
alone. This study also had 9/41 (22%) patients who were able to be down-staged to surgical resection
following treatment with SIRT plus chemotherapy. These findings suggest that SIRT with concomitant