2324 - The Clinical Outcomes of Systemic Chemotherapy in Patients with Unresectable or Metastatic Combined Hepatocellular-cholangiocarcinoma (HCC-CCA): Retrospective Study of 120 Patients

Background

Combined HCC-CCA is rare malignancy with incidence of less than 5% of primary hepatic malignancies. Because combined HCC-CCA has been excluded in clinical trials for either HCC or CCA, optimal systemic chemotherapy regimen has not been defined yet for combined HCC-CCA. Therefore, we analyzed efficacy of systemic chemotherapy in patients with unresectable or metastatic combined HCC-CCA.

Methods

Among patients with histologically confirmed combined HCC-CCA from 1999 to 2015 in Asan Medical Center, Seoul, Korea, 120 patients who received systemic chemotherapy for unresectable or metastatic disease were identified and included in this analysis. Overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) were retrospectively evaluated.

Results

15 patients had initially metastatic disease and the other 105 patients had recurrent or progressive disease after local therapy. Sorafenib (n = 69, 56.7%), gemcitabine plus cisplatin (GP) (n = 21, 17.5%), 5-FU-based chemotherapy (n = 22, 19.2%) were most frequently used regimens. Overall, ORR was 10.8%, and median PFS and OS was 4.2 (95% CI 3.0-5.5) and 9.0 months (7.0-11.1), respectively with median follow-up of 39.6 months (24.8-54.3). ORR, PFS and OS did not differ according to chemotherapy regimens (ORR, 7.2%, 13.7% and 18.2%, p = 0.30; median PFS, 4.6 [95% CI 3.8-5.4], 3.7 [1.8-5.6] and 7.9 months [0.5-15.2], p = 0.67; and median OS, 9.8 [7.5-12.1], 8.8 [6.8-10.8], and 8.8 months [4.9-12.7], p = 0.62 in patients with sorafenib, GP, and 5-FU-based chemotherapy, respectively). In univariate analysis, elevated baseline carcinoembryonic antigen (CEA) level, liver cirrhosis (LC) and large tumor burden (≥30% of liver volume) were significantly associated with poorer OS, and these remained significant in multivariate analysis (HR 2.29, 95% CI, 1.26-4.14, p = 0.006 for elevated CEA level; HR 1.67, 1.03-2.70, p = 0.04 for LC; HR 4.75, 2.22-10.16, p < 0.001 for large tumour burden).

Conclusions

Patients with advanced HCC-CCA treated with systemic chemotherapy showed poor prognosis. Further clinical trials to understand biology of combined HCC-CCA and find optimal systemic agents are needed.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.