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The postprogression survival of patients with intrahepatic cholangiocarcinoma is influenced by the pattern of cancer progression, a new study published in the journal Liver International found.

This finding has important implications for the design and analysis of second-line trials, according to Franceso Tovoli, MD, of the Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy, and the coauthors of the study.

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Dividing the cancer progression pattern according to whether new extrahepatic lesions were present, the researchers evaluated the progression of the disease based on radiological assessment in 206 patients with intrahepatic cholangiocarcinoma.

The patients had received a frontline systemic treatment either with gemcitabine alone or gemcitabine plus platinum. Their median overall survival was 14.1 months.

The independent predictors of overall survival were previous surgery, performance status, permanent first-line discontinuation, registration of ascites or bilirubin higher than 3 mg/dL during follow-up, and disease progression.

Of the 206 patients, 138 were eligible for second-line treatment. Among them, postprogession survival was 16.8 months if new extrahepatic lesions were not present but 5.9 months if they were present. 

Progression due to the presence of new extrahepatic lesions was an independent predictor of postprogression survival. Other independent predictors of postprogression survival were performance status, time-to-progression to the frontline treatment, bilirubin levels higher than 3 mg/dL, and ascites.

“In conclusion, we found that the [intrahepatic cholangiocarcinoma] radiological pattern of progression influences the postprogression outcomes, both in a pure population of progressors,  and in candidates to second-line trials,” the researchers wrote. “ This information can refine the information deriving from existing prognostic tools and have repercussions on the design of future clinical trials.”

Intrahepatic cholangiocarcinoma is the second most common type of hepatic cancer, the overall survival of which is still poor. 


Tovoli F, Garajová I, Gelsomino F, et al. Pattern of progression of intrahepatic cholangiocarcinoma: implications for second-line clinical trials. Liver Int. Published online November 26, 2021. doi:10.1111/liv.15117