Neoadjuvant Multiagent Systemic Therapy Approach to Liver Transplantation for Perihilar Cholangiocarcinoma
Background. Perihilar cholangiocarcinoma (phCCA) has excellent outcomes following liver transplantation (LT). Neoadjuvant radiation-based locoregional therapy is standard-of-care. Gemcitabine and cisplatin (gem/cis) combination systemic therapies have improved outcomes in advanced settings, but thei...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2025-03-01
|
| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001760 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850078264874237952 |
|---|---|
| author | Nadine Soliman, MD Ashton A. Connor, MD, PhD Ashish Saharia, MD Sudha Kodali, MD, MSPH Ahmed Elaileh, MD Khush Patel, MD, MS Samar Semaan, MD Tamneet Basra, MD David W. Victor, III, MD Caroline J. Simon, MD Yee Lee Cheah, MD Mark J. Hobeika, MD Constance M. Mobley, MD, PhD Mukul Divatia, MD Sadhna Dhingra, MD Mary Schwartz, MD Anaum Maqsood, MD Kirk Heyne, MD Maen Abdelrahim, MD, PhD Milind Javle, MD Jean-Nicolas Vauthey, MD A. Osama Gaber, MD R. Mark Ghobrial, MD, PhD |
| author_facet | Nadine Soliman, MD Ashton A. Connor, MD, PhD Ashish Saharia, MD Sudha Kodali, MD, MSPH Ahmed Elaileh, MD Khush Patel, MD, MS Samar Semaan, MD Tamneet Basra, MD David W. Victor, III, MD Caroline J. Simon, MD Yee Lee Cheah, MD Mark J. Hobeika, MD Constance M. Mobley, MD, PhD Mukul Divatia, MD Sadhna Dhingra, MD Mary Schwartz, MD Anaum Maqsood, MD Kirk Heyne, MD Maen Abdelrahim, MD, PhD Milind Javle, MD Jean-Nicolas Vauthey, MD A. Osama Gaber, MD R. Mark Ghobrial, MD, PhD |
| author_sort | Nadine Soliman, MD |
| collection | DOAJ |
| description | Background. Perihilar cholangiocarcinoma (phCCA) has excellent outcomes following liver transplantation (LT). Neoadjuvant radiation-based locoregional therapy is standard-of-care. Gemcitabine and cisplatin (gem/cis) combination systemic therapies have improved outcomes in advanced settings, but their efficacy pre-LT has not been studied.
Methods. We review our experience following neoadjuvant gem/cis alone versus radiation-based approaches. Patients with phCCA undergoing LT at a single center between January 2008 and February 2023 were identified retrospectively. Neoadjuvant therapy was categorized as gem/cis systemic therapy (ST) alone, or any ST and radiotherapy (RT). Outcomes were posttransplant overall survival (OS), recurrence-free survival (RFS), waitlist time, and pathologic tumor response.
Results. During study period, 27 phCCA patients underwent LT. One patient decompensated with neoadjuvant therapy and was excluded. Median age was 61 y (interquartile range, 53–68 y) and 14 (54%) were male. Of 26 patients, 12 (46%) received ST and 14 (54%) RT. Six RT patients received gem/cis ST. Median waitlist time was 199 d (interquartile range, 98–405 d) and did not differ by neoadjuvant regimen. Explanted tumors were predominantly T1 stage, without lymphovascular invasion or nodal involvement. Neither pathologic features nor percent tumor necrosis differed by regimen. OS probabilities at 1 and 3 y were 84% and 55% for the cohort. There was no significant difference in OS and RFS when stratified by regimen.
Conclusions. Post-LT OS, RFS, waitlist time, and tumor response were similar in the 2 groups. Patients with phCCA who do not undergo RT may still be considered for LT under appropriate institution-based protocols that adhere to other established criteria. |
| format | Article |
| id | doaj-art-5944494adc99487db0b39f747d156e5f |
| institution | DOAJ |
| issn | 2373-8731 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj-art-5944494adc99487db0b39f747d156e5f2025-08-20T02:45:37ZengWolters KluwerTransplantation Direct2373-87312025-03-01113e176010.1097/TXD.0000000000001760202503000-00002Neoadjuvant Multiagent Systemic Therapy Approach to Liver Transplantation for Perihilar CholangiocarcinomaNadine Soliman, MD0Ashton A. Connor, MD, PhD1Ashish Saharia, MD2Sudha Kodali, MD, MSPH3Ahmed Elaileh, MD4Khush Patel, MD, MS5Samar Semaan, MD6Tamneet Basra, MD7David W. Victor, III, MD8Caroline J. Simon, MD9Yee Lee Cheah, MD10Mark J. Hobeika, MD11Constance M. Mobley, MD, PhD12Mukul Divatia, MD13Sadhna Dhingra, MD14Mary Schwartz, MD15Anaum Maqsood, MD16Kirk Heyne, MD17Maen Abdelrahim, MD, PhD18Milind Javle, MD19Jean-Nicolas Vauthey, MD20A. Osama Gaber, MD21R. Mark Ghobrial, MD, PhD221 Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.4 Sherrie and Alan Conover Center for Liver Disease and Transplantation, Department of Medicine, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.4 Sherrie and Alan Conover Center for Liver Disease and Transplantation, Department of Medicine, Houston Methodist Hospital, Houston, TX.4 Sherrie and Alan Conover Center for Liver Disease and Transplantation, Department of Medicine, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.6 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX.6 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX.6 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX.7 Division of Medical Oncology, Department of Medicine, Houston Methodist Hospital, Houston, TX.5 Department of Medicine, Weill Cornell Medical College, New York, NY.5 Department of Medicine, Weill Cornell Medical College, New York, NY.8 Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.9 Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.2 Department of Surgery, Houston Methodist Hospital, Houston, TX.Background. Perihilar cholangiocarcinoma (phCCA) has excellent outcomes following liver transplantation (LT). Neoadjuvant radiation-based locoregional therapy is standard-of-care. Gemcitabine and cisplatin (gem/cis) combination systemic therapies have improved outcomes in advanced settings, but their efficacy pre-LT has not been studied. Methods. We review our experience following neoadjuvant gem/cis alone versus radiation-based approaches. Patients with phCCA undergoing LT at a single center between January 2008 and February 2023 were identified retrospectively. Neoadjuvant therapy was categorized as gem/cis systemic therapy (ST) alone, or any ST and radiotherapy (RT). Outcomes were posttransplant overall survival (OS), recurrence-free survival (RFS), waitlist time, and pathologic tumor response. Results. During study period, 27 phCCA patients underwent LT. One patient decompensated with neoadjuvant therapy and was excluded. Median age was 61 y (interquartile range, 53–68 y) and 14 (54%) were male. Of 26 patients, 12 (46%) received ST and 14 (54%) RT. Six RT patients received gem/cis ST. Median waitlist time was 199 d (interquartile range, 98–405 d) and did not differ by neoadjuvant regimen. Explanted tumors were predominantly T1 stage, without lymphovascular invasion or nodal involvement. Neither pathologic features nor percent tumor necrosis differed by regimen. OS probabilities at 1 and 3 y were 84% and 55% for the cohort. There was no significant difference in OS and RFS when stratified by regimen. Conclusions. Post-LT OS, RFS, waitlist time, and tumor response were similar in the 2 groups. Patients with phCCA who do not undergo RT may still be considered for LT under appropriate institution-based protocols that adhere to other established criteria.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001760 |
| spellingShingle | Nadine Soliman, MD Ashton A. Connor, MD, PhD Ashish Saharia, MD Sudha Kodali, MD, MSPH Ahmed Elaileh, MD Khush Patel, MD, MS Samar Semaan, MD Tamneet Basra, MD David W. Victor, III, MD Caroline J. Simon, MD Yee Lee Cheah, MD Mark J. Hobeika, MD Constance M. Mobley, MD, PhD Mukul Divatia, MD Sadhna Dhingra, MD Mary Schwartz, MD Anaum Maqsood, MD Kirk Heyne, MD Maen Abdelrahim, MD, PhD Milind Javle, MD Jean-Nicolas Vauthey, MD A. Osama Gaber, MD R. Mark Ghobrial, MD, PhD Neoadjuvant Multiagent Systemic Therapy Approach to Liver Transplantation for Perihilar Cholangiocarcinoma Transplantation Direct |
| title | Neoadjuvant Multiagent Systemic Therapy Approach to Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_full | Neoadjuvant Multiagent Systemic Therapy Approach to Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_fullStr | Neoadjuvant Multiagent Systemic Therapy Approach to Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_full_unstemmed | Neoadjuvant Multiagent Systemic Therapy Approach to Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_short | Neoadjuvant Multiagent Systemic Therapy Approach to Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_sort | neoadjuvant multiagent systemic therapy approach to liver transplantation for perihilar cholangiocarcinoma |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001760 |
| work_keys_str_mv | AT nadinesolimanmd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT ashtonaconnormdphd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT ashishsahariamd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT sudhakodalimdmsph neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT ahmedelailehmd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT khushpatelmdms neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT samarsemaanmd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT tamneetbasramd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT davidwvictoriiimd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT carolinejsimonmd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT yeeleecheahmd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT markjhobeikamd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT constancemmobleymdphd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT mukuldivatiamd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT sadhnadhingramd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT maryschwartzmd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT anaummaqsoodmd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT kirkheynemd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT maenabdelrahimmdphd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT milindjavlemd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT jeannicolasvautheymd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT aosamagabermd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma AT rmarkghobrialmdphd neoadjuvantmultiagentsystemictherapyapproachtolivertransplantationforperihilarcholangiocarcinoma |