Antibiotics or percutaneous transhepatic cholangial drainage in patients with cholangiocarcinoma (CCA) receiving immune checkpoint blockade therapy is associated with worse overall survival, according to a new study published in the journal BMC Cancer

The study also found that percutaneous transhepatic cholangial drainage affects the gut microbiota and that patients receiving this treatment had significantly reduced Escherichia-Shigella in their feces. 

Read more about the CCA treatment

Continue Reading

The authors said that the best survival is obtained through a combination of immune checkpoint blockade plus chemotherapy, especially in patients not undergoing percutaneous transhepatic cholangial drainage.

Percutaneous transhepatic cholangial drainage is often used in patients with advanced CCA to treat bile duct obstruction, the researchers noted. However, the treatment can have a negative effect on the efficacy of immunotherapy by disturbing the gut microbiota, they added.

In the present study, a team of researchers from China assessed the potential effect of percutaneous transhepatic cholangial drainage and antibiotics on overall and progression-free survival in patients with advanced CCA treated with first-line chemotherapy plus immune checkpoint blockade.

The researchers analyzed 107 patients with CCA. They found that immune checkpoint blockade therapy combined with chemotherapy significantly improved overall and progression-free survival compared to chemotherapy alone in patients who did not have percutaneous transhepatic cholangial drainage.

However, in patients who did receive percutaneous transhepatic cholangial drainage, the combination therapy did not improve survival compared to chemotherapy alone. 

There were also significant reductions inEscherichia-Shigella in the feces of patients following percutaneous transhepatic cholangial drainage.

Percutaneous transhepatic cholangial drainage is an interventional surgery involving the insertion of a catheter to drain the bile and treat bile duct obstructions, a common problem in patients with advanced CCA. However, patients treated with this approach lose large amounts of digestive fluids leading to gut microbiota disruptions, thereby disturbing antitumor immunity, and affecting the efficacy of immunotherapy.


Huang Q, Wang F, Zhang X, et al. Percutaneous transhepatic cholangial drainage or antibiotic therapy worsens response to immunotherapy in advanced cholangiocarcinoma. BMC Cancer. Published online July 13, 2023. doi:10.1186/s12885-023-11128-2