Adjuvant therapy for intrahepatic carcinoma after surgical resection:chemotherapy and future perspectives

Intrahepatic cholangiocarcinoma is a highly aggressive and malignant liver cancer.The main reason for its poor prognosis is the low opportunity of surgery and the high rates of postoperative recurrence and metastasis.Thus,reducing postoperative recurrence and metastasis rate is the key to improving prognosis.Although some retrospective studies have attested to the value of adjuvant therapy in patients with R1 resection or N1/T3/T4 intrahepatic cholangiocarcinoma(1),no recommended standard yet exists in intrahepatic cholangiocarcinoma primarily because the only 2 completed phase III clinical trials,the PRODIGE 12-ACCORD 18 trial(2)and the BILCAP trial(3),failed to achieve survival benefit in the chemotherapy arm in the adjuvant setting.However,one of the possible reasons for the negative results of the 2 studies is that patients with R1/N1/T3/T4 were not differentiated.One randomized phase III trials(JCOG1202,ASCOT)of adjuvant S-1 therapy vs.observation alone in resected biliary tract cancer(4)and one trial(ACTICCA-1 trial)of adjuvant chemotherapy with gemcitabine and cisplatin compared to observation after resection of cholangiocarcinoma and muscle invasive gallbladder carcinoma(5)are ongoing and awaiting future results.