Hepatic arterial infusion chemotherapy in combination with immune checkpoint inhibitors and targeted therapy for advanced intrahepatic cholangiocarcinoma.
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BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer. It tends to metastasize even at the small neoplasm stage, and the prognosis for advanced ICC remains poor, with a five-year survival rate of merely 5%. Chemotherapy combined with immune checkpoint inhibitors (ICIs) has become the standard first-line treatment for unresectable ICC, while hepatic arterial infusion chemotherapy (HAIC) has shown promising efficacy in ICC. This study aimed to evaluate the efficacy of HAIC in combination with ICIs and multi-targeted therapy for advanced ICC. METHODS: From January 11, 2022 to April 30, 2024, a total of 57 patients with advanced ICC who received HAIC combined with systemic ICIs and targeted therapy were enrolled in our department. Overall survival (OS) and progression free survival (PFS) were the primary endpoints. PFS and OS were estimated using the Kaplan-Meier method. Factors affecting PFS and OS were analyzed by the Cox regression analysis. RESULTS: According to Response Evaluation Criteria in Solid Tumours 1.1 (RECIST 1.1), the objective response rate (ORR) was 35.1% and the disease control rate (DCR) was 73.7%. The median PFS was 4.5 [95% confidence interval (CI), 3.1-5.8] months, and the median OS was 12.0 (95% CI, 8.1-15.8) months. Carbohydrate antigen 19-9 (CA19-9), aspartate aminotransferase (AST), and Child-Pugh class were independent risk factors for patient survival. CONCLUSIONS: Locoregional HAIC combined with systemic ICIs plus targeted therapy is a critical alternative strategy for advanced ICC, which needs to be validated by further prospective studies.