Armeen Mahvash, MD Interventional Radiology UT MD Anderson Cancer Center Locoregional Therapies for Cholangiocarcinoma
May 31, 2015
Armeen Mahvash, MDInterventional RadiologyUT MD Anderson Cancer Center
Locoregional Therapies for Cholangiocarcinoma
Treatment Options
Ablation Radiofrequency Microwave Irreversible Electroporation (abstract)
Transarterial Chemoembolization (TACE) Conventional / Oily TACE Drug Eluting Bead TACE
Selective Internal Radiation Therapy / Yttrium 90 Radioembolization Therasphere / Glass - HCC SIRSpheres / Resin - CRC
Ablative Therapy in ICC
Reference Patients Lesions Type Size/Success Median LPFS Median OS Complication
Kim, 2011 13 17 RFA <5cm/100%
>5cm/0%
32 months 38 months Abscess/ Death
Giorgio, 2011
101 Recurrent9 Primary
12 RFA <3.4cm/100%
>4cm/ 0%
Primary – 83% alive at 5yrs
None
Yu, 2011 15 24 MW <5cm/90%
>5cm/33%
10 months Abscess x 2Seeding
Xu, 2012 1810 Recurrent8 Primary
25 RFA/MW <4.3cm/100%>6.4cm/0%
RFS - months
Recurrent- 6 months Primary –29 months
FeverPartial PVT
Metaanalysis of TACE for ICC
Ray, JVIR, 2013
Conventional TACEReference Patients Chemotherapy Prior Chemo Extrahepatic
DiseaseMedian OS Complications
Herber, 2007 1558 sessions
Mitomycin C 4 None 16 months GI ulcer
Gusani,2008 42199 sessions
Gemcitabine, Cisplatin, OxaliplatinTACI+Embo
NA 45% 9months AMIAbscessBilirubin x 2Platelets x 2
Park, 2011 72 TACE2.5 session/pt83 BSC
Cisplatin NA 72% TACE – 12 mBSC – 3 m
Grade 3 – 24%
Keifer, 2011 62165 session
Cisplatin, Doxorubicin, Mitomycin
29% 31% 15 months Grade 3 – 5 pts
Vogl,2011 115819 session
Various NA None 13 months None
Scheuermann, 2013
32131 session
Mitomycin -29DEB - 3
NA NR 11 months Sepsis x 3
Hyder, 2013 1982 sessions/pt
TACE – 65%DEB – 6%TAE- 6%Y90 – 23%
28% TACE – 13 mDEB – 10 mTAE – 14 mY90 – 11 m
Grade 3 - 8%
Drug Eluting Bead(DEB) TACEReference Patients Chemotherap
yPrior Chemo
Extrahepatic Disease
Median OS Complications
Aliberti, 2008 1129 sessions
Doxorubicin75mg/150mg
No No 13 months Abscess
Poggi, 2009 930 sessions37 cycles
Oxaliplatin 50mg + Oxaliplatin/Gemcitabine Systemic Chemo
No No 30 months Grade 3 – 11%
Kuhlmann, 2012
2641 sessions
Irinotecan 200mg
19% 51% 11.7 months Grade 3 – 9/26Grade 5 - 1
Yttrium 90 Radioembolization
Reference Patients Device Prior Chemo Extrahepatic Mets
Median OS Complications
Saxena, 2010 2525 sessions
SS/resin 72% 48% 9 months Grade 3 – 12%Death x 2
Hoffman, 2012
3334 sessions
SS/resin 79% 24% 22 months Grade 3 - 0%
Mouli, 2013 4692 sessions
TS/glass 35% 35% Peripheral – 15 monthsInfiltrative – 6 months
Grade 3 – 18%
Rafi, 2013 1924 sessions
SS/resin 100% 58% 345 days Grade 3 – 11%
Future Direction
Prospective Trials Needed Combination Therapy
Locoregional + Systemic