• Cancer

    Chemo first for better outcomes in bile duct cancer, says new research

medical illustration of cholangiocarcinoma showing liver, bile ducts, labeled parts

Oncology care teams frequently use chemotherapy along with surgery to treat cholangiocarcinoma, or bile duct cancer. However, until now, little evidence existed regarding if and when receiving chemotherapy was likely to have the best effect.

Recently Mayo Clinic researchers found that patients who received chemotherapy before surgery to remove their bile duct cancer were more likely to live longer than patients who received chemotherapy after surgery. Their findings are published in the European Journal of Surgical Oncology.

“Cholangiocarcinoma is a rare malignancy with poor outcomes and limited treatment options,” says Siddhartha Yadav, M.D., F.A.C.P., study first author, and a hematology/oncology fellow at Mayo Clinic in Rochester, Minnesota. “We hope that our findings will lead to clinical trials to further evaluate the role of neoadjuvant chemotherapy in cholangiocarcinoma and significantly improve the outcomes of patients with this rare and aggressive tumor.”

According to the American Cancer Society, cholangiocarcinoma is rare, with about 8,000 people in the U.S. diagnosed each year. The outlook for these patients is not good, with 5-year survival rates ranging from less than 25% in the best case (localized cancer, within the liver), and 1% worst case (cancer has spread beyond bile ducts to distant parts of the body).

“At Mayo Clinic, we get referrals from all over the world to our tertiary care center,” says Amit Mahipal, M.B.B.S., study senior author, and a gastrointestinal oncologist at Mayo Clinic in Rochester, Minnesota. “We do research into rare conditions because little research exits for these conditions due to small numbers. But because of our unique institution and patient population, we are able to conduct research with select groups of patients with rare diseases like cholangiocarcinoma.”

The researchers used the National Cancer Database to identify patients who underwent surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014. Of 1,450 patients, the team found that 299 received chemotherapy before surgery, and 1,151 received it after surgery. They investigated subgroups of these, matching 278 patients who received pre-surgery chemo to 700 patients with similar characteristics to the post-surgery chemo group.

On average, the patients who received chemotherapy before surgery lived 7.5 months longer than those receiving it after surgery. Their 5-year survival rate was also more than 10% higher (42.5% versus 31.7%).

“We have other research showing neoadjuvant (before surgery) chemotherapy nets better results for patients with pancreatic or breast cancer,” says Dr. Mahipal, “so these results were not very surprising. However, because of this research, we now know what the best practice should be, and we hope to see application of this evidence into treatment for patients everywhere with bile duct cancer.”

This research was the result multidisciplinary collaboration across several departments at Mayo Clinic and Yale New Haven Health. It was supported by Mayo Clinic Cancer Center and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. This study was presented in part as a poster presentation at the 2018 European Society of Medical Oncology Annual Congress in Munich, Germany.