Is it a new era for intrahepatic cholangiocarcinoma?

Area of Science:

• Hepatobiliary cancers
• Gastroenterology
• Oncology

Background:

• Intrahepatic cholangiocarcinoma (iCCA) is distinct from other biliary tract cancers due to unique characteristics.
• Surgical resection is curative for a minority (~30%) of iCCA patients.
• Advanced iCCA treatment landscape is evolving beyond standard chemotherapy.

Purpose of the Study:

• To review current therapeutic strategies for intrahepatic cholangiocarcinoma across all disease stages.
• To discuss emerging treatments and future directions for iCCA management.
• To highlight the significance of molecular alterations in guiding iCCA treatment.

Main Methods:

• Comprehensive literature review of iCCA treatment modalities.
• Analysis of surgical, liver-directed therapies, and systemic treatment options.
• Exploration of targeted therapies based on molecular profiling.

Main Results:

• Surgery is the primary curative option for resectable iCCA.
• Liver-directed therapies (LDTs) and transplant are options for unresectable liver-only disease.
• Chemoimmunotherapy is first-line for advanced iCCA; targeted therapies are increasingly used in later lines for patients with actionable mutations (~40%).

Conclusions:

• The management of intrahepatic cholangiocarcinoma requires a multidisciplinary approach.
• Personalized treatment strategies, including targeted therapies, are essential for improving outcomes.
• Ongoing research is critical for advancing the therapeutic options for iCCA.