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Published on: February 12, 2017
Conversion to Resection After Neoadjuvant Gemcitabine, Cisplatin, and Nab-Paclitaxel for Borderline Resectable CCA: A
Yawen Dong1,2, Jonas Santol1,2, Vanja Podrascanin1,3
1Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Background:
This study aimed to evaluate the feasibility and clinical outcomes of neoadjuvant triplet therapy with gemcitabine, cisplatin, and nab-paclitaxel (GAP) for patients with borderline resectable cholangiocarcinoma (CCA). Given the surgical complexity associated with borderline resectable disease, the study sought to explore whether GAP could serve as a suitable neoadjuvant regimen to enable conversion to resection and improve prognosis in this high-risk setting.
Methods:
The study enrolled patients with borderline resectable CCA receiving neoadjuvant GAP between July 2019 and February 2024. Rates of conversion to surgery, perioperative safety, radiologic and pathologic treatment responses, and survival outcomes were evaluated.
Results:
Of 108 screened patients, 71 (65.7%) with anatomically or biologically borderline resectable CCA received neoadjuvant GAP therapy, 34 (47.9%) of whom underwent curative-intent resection. Among the resected patients, 50.0% underwent extended hepatectomy, 32.4% underwent extrahepatic bile duct resection, and 14.7% underwent vascular reconstruction. Radiologic evaluation showed an overall response rate of 50.0% and a disease control rate of 94.1%. Grade ≥3 treatment-related adverse events were observed in 21% of the patients, primarily involving hematologic toxicities. Major postoperative complications occurred for 35.3% of the patients, with no 90-day mortalities. The resected patients demonstrated significantly better overall survival (OS) than the non-resected patients (median OS, 68.7 vs. 24.4 months; p < 0.001).
Conclusion:
Neoadjuvant GAP demonstrated promising efficacy for borderline resectable CCA, with favorable response rates and the potential to facilitate curative-intent resection. However, its use is mitigated by treatment-related toxicity, emphasizing the significance of careful patient selection. Further prospective studies are warranted to validate its role in optimizing surgical and long-term oncologic outcomes.
