PDF(Pubmed)
Abstract：
UNASSIGNED: The incidence of intrahepatic cholangiocarcinoma (IHCCA) is rising around the world. The disease is becoming a major global health issue. Conventionally, most patients with cholangiocarcinoma present with advanced disease and systemic therapy is the mainstay of treatment. This review discusses recent advances in systemic treatments for patients with IHCCA.
UNASSIGNED: The addition of durvalumab to a gemcitabine plus cisplatin regimen has significantly improved overall survival in the phase 3 TOPAZ-1 trial and is currently recommended as a standard first-line treatment. The phase 3 ABC-06 and phase 2b NIFTY trials have shown the benefit of second-line fluoropyrimidine plus oxaliplatin, and fluoropyrimidine plus nanoliposomal irinotecan, respectively. They have provided a treatment option for patients without actionable alterations who progressed to first-line therapy. For patients with actionable genomic alterations, including FGFR2 rearrangement, IDH1 mutation, BRAF mutation, and ERBB2 amplification, targeted agents have shown encouraging efficacy in several phase 2-3 trials, and are recommended as subsequent treatments. Immune checkpoint inhibitors are being investigated for the treatment of previously treated patients, although only a small proportion of patients showed durable responses.
UNASSIGNED: Recent advances in systemic treatments have improved clinical outcomes in patients with advanced IHCCA. However, most patients eventually show resistance to the treatment, and tumor progression occurs within a year. Indeed, there should be further efforts to improve the outcomes of patients with advanced IHCCA.
UNASSIGNED: The addition of durvalumab to a gemcitabine plus cisplatin regimen has significantly improved overall survival in the phase 3 TOPAZ-1 trial and is currently recommended as a standard first-line treatment. The phase 3 ABC-06 and phase 2b NIFTY trials have shown the benefit of second-line fluoropyrimidine plus oxaliplatin, and fluoropyrimidine plus nanoliposomal irinotecan, respectively. They have provided a treatment option for patients without actionable alterations who progressed to first-line therapy. For patients with actionable genomic alterations, including FGFR2 rearrangement, IDH1 mutation, BRAF mutation, and ERBB2 amplification, targeted agents have shown encouraging efficacy in several phase 2-3 trials, and are recommended as subsequent treatments. Immune checkpoint inhibitors are being investigated for the treatment of previously treated patients, although only a small proportion of patients showed durable responses.
UNASSIGNED: Recent advances in systemic treatments have improved clinical outcomes in patients with advanced IHCCA. However, most patients eventually show resistance to the treatment, and tumor progression occurs within a year. Indeed, there should be further efforts to improve the outcomes of patients with advanced IHCCA.
摘要：
■肝内胆管癌（IHCCA）的发病率在世界范围内呈上升趋势。这种疾病正在成为一个重大的全球健康问题。传统上,大多数胆管癌患者表现为晚期疾病，系统治疗是治疗的主要手段。这篇综述讨论了IHCCA患者全身治疗的最新进展。
■在3期TOPAZ-1试验中，在吉西他滨加顺铂方案中添加durvalumab可显着改善总生存率，目前被推荐为标准一线治疗。3期ABC-06和2b期NIFTY试验显示了二线氟嘧啶加奥沙利铂的益处，氟嘧啶加纳米脂质体伊立替康，分别。他们为进展到一线治疗的无可操作改变的患者提供了治疗选择。对于具有可操作基因组改变的患者，包括FGFR2重排，IDH1突变,BRAF突变,和ERBB2扩增，靶向药物在几个2-3期试验中显示出令人鼓舞的疗效，并建议作为后续治疗。免疫检查点抑制剂正在研究用于治疗先前治疗的患者，尽管只有一小部分患者表现出持久的反应。
■系统治疗的最新进展改善了晚期IHCCA患者的临床预后。然而,大多数患者最终表现出对治疗的抵抗力，肿瘤在一年内进展。的确,应进一步努力改善晚期IHCCA患者的预后.
■在3期TOPAZ-1试验中，在吉西他滨加顺铂方案中添加durvalumab可显着改善总生存率，目前被推荐为标准一线治疗。3期ABC-06和2b期NIFTY试验显示了二线氟嘧啶加奥沙利铂的益处，氟嘧啶加纳米脂质体伊立替康，分别。他们为进展到一线治疗的无可操作改变的患者提供了治疗选择。对于具有可操作基因组改变的患者，包括FGFR2重排，IDH1突变,BRAF突变,和ERBB2扩增，靶向药物在几个2-3期试验中显示出令人鼓舞的疗效，并建议作为后续治疗。免疫检查点抑制剂正在研究用于治疗先前治疗的患者，尽管只有一小部分患者表现出持久的反应。
■系统治疗的最新进展改善了晚期IHCCA患者的临床预后。然而,大多数患者最终表现出对治疗的抵抗力，肿瘤在一年内进展。的确,应进一步努力改善晚期IHCCA患者的预后.
