Transarterial chemoembolization of intrahepatic cholangiocarinoma with irinotecan-eluting beads: preliminary results

Purpose: Patients with unresectable cholangiocarcinoma have a poor prognosis with no standard systemic chemotherapy being established so far. According to recent publications patients with intrahepatic cholangiocarcinoma even respond to chemotherapy to a lesser extent than patients with extrahepatic choangiocarcinoma. Therefore, we performed a pilot study to evaluate the feasibility, safety, and efficacy of transarterial chemoembolization with drug-eluting beads (DEB-TACE) in patients with intrahepatic cholangiocarcinoma.

Methods: Thirteen patients (7 female, 6 male) with unresectable intrahepatic cholangiocarcinoma and without evidence of extrahepatic tumor manifestation, aged 48 to 76 years (mean 66 years), underwent 21 sessions of DEB-TACE loaded with 200mg irinotecan between November 2007 and December 2008. Prior to DEB-TACE 7 patients (54%) had progressive disease and 2 (16%) had untolerable side effects under systemic chemotherapy, 3 patients (23%) had contraindications to and 1 (8%) patient refused systemic chemotherapy. Progression free survival was evaluated in 8 weeks intervals after therapy with computed tomography (CT) or magnetic resonance imaging (MRI) according to Response Evaluation Criteria in Solid Tumors (RECIST). Clinical and laboratory data were assessed for side effects according to NCI-CTC.

Results: All 21 sessions of DEB-TACE were safely performed with no serious complications. 4 patients (31%) reported of heavy (grade 3) and 6 (46%) of moderate (grade 1 and 2) pain in the right upper abdomen up to two weeks after treatment. No haematological side effects or impairment of liver function tests (≥ grade 3) were observed. The median follow-up was 11 months (range, 4–16 months). Sixteen weeks after TACE, one patient (7%) had a partial response and was treated by liver resection, 8 of 13 patients (62%) had stable and 4 of 13 patients (31%) had progessive disease according to intention to treat analysis. Eight patients have no tumor progression so far with a mean progression free survival of 8.6 months.

Conclusions: DEB-TACE with irinotecan is well tolerated and appears effective in patients with intrahepatic CCC. Even in patients pretreated with systemic chemotherapy DEB-TACE can lead to long lasting responses.