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October 31, 2019

Moving the Needle Forward With Locoregional Treatment in Unresectable Cholangiocarcinoma—The Jury Is Still Out

Author Affiliations
  • 1Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson
JAMA Oncol. 2020;6(1):29-31. doi:10.1001/jamaoncol.2019.3691

Cholangiocarcinomas are epithelial cell tumors that originate within the biliary tree and comprise 3 subtypes: intrahepatic, perihilar, and distal.1 Intrahepatic cholangiocarcinoma (ICC) accounts for approximately 20% of all cholangiocarcinomas diagnosed in the United States.1,2 The incidence and mortality associated with ICC have been increasing over the past several decades related to an increase in known risk factors, such as nonalcoholic steatohepatitis, hepatitis C, and cirrhosis.3 Intrahepatic cholangiocarcinoma is an aggressive cancer often diagnosed in advanced stages owing to a lack of adequate early detection, its insidious clinical character, challenging anatomic access, and limitations of pathologic and cytologic diagnostic tools. Because of these factors, only approximately 35% of patients diagnosed with cholangiocarcinoma will have tumors amenable to curative intent resection at time of diagnosis.4 Prognosis is especially poor for the majority of patients diagnosed with unresectable biliary tract cancers, with median overall survival limited to less than 1 year.5 For most cases, surgical approaches are generally not indicated and recurrence rates remain high even in the minority of patients who respond to treatment and are able to undergo surgical resection. Approaches to improve survival outcomes for patients with unresectable ICC remain a grave unmet need.

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