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.
■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.