In Reply We thank Yang and colleagues for their interest and appreciation of our phase 2 trial.1 In their letter, they address the significant improvement in overall survival (OS) with the combination of regional hepatic arterial infusion (HAI) therapy plus systemic gemcitabine and oxaliplatin. In particular, they note the larger difference between the median progression-free survival (PFS) (11.8 months) and median OS (25.0 months) achieved with this combination in our study compared with that achieved with systemic gemcitabine and cisplatin alone in the Advanced Biliary Tract Cancer (ABC) trials (difference between median PFS and OS, 7.0 months).2 In our study, patients received a median of 5 cycles (range, 1-25) of HAI floxuridine and 21 cycles (range, 5-36) of gemcitabine on protocol, and we hypothesize that early and adequate treatment of the primary liver tumor led to longer survival owing to preservation of liver function even in the setting of metastatic disease. This is further supported by a second study of locoregional therapy with radioembolization demonstrating a similar difference in PFS and OS.3
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Cercek A, Jarnagin WR. Locoregional Therapy Plus Systemic Chemotherapy in Unresectable Intrahepatic Cholangiocarcinoma—Reply. JAMA Oncol. Published online April 09, 2020. doi:10.1001/jamaoncol.2020.0343
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