FOLFIRI plus bevacizumab as a second-line therapy for metastatic intrahepatic cholangiocarcinoma

AIM:To evaluate the efficacy and tolerance of FOLFIRI plus bevacizumab treatment outcome as second-line treatment for metastatic intrahepatic cholangiocarcinoma.METHODS:Thirteen consecutive patients with metastatic intrahepatic cholangiocarcinoma who were refractory tofirst-line therapy consisting of gemcitabine plus oxaliplatinbased first-line chemotherapy given intravenously via intra-arterial infusion were treated with FOLFIRI[irinotecan(180 mg/m2 i.v.over 90 min)concurrently with folinic acid(400 mg/m2 i.v.over 120 min)followed by fluorouracil(400 mg/m2 i.v.bolus)then fluorouracil 2400 mg/m2 intravenous infusion over 46 h]and bevacizumab(5mg/kg)every 2 wk.Tumor response was evaluated by computed tomography scan every 4 cycles.RESULTS:The best tumor responses using response evaluation criteria in solid tumor criteria were:complete response for 1 patient,partial response for 4 patients,and stable disease for 6 patients after 6 mo of follow-up.The response rate was 38.4%(95%CI:12.5-89)and the disease control rate was 84.5%(95%CI:42-100).Seven deaths occurred at the time of analysis,progression free survival was 8 mo(95%CI:7-16),and median overall survival was 20 mo(95%CI:8-48).No grade 4toxic events were observed.Four grade 3 hematological toxicities and one grade 3 digestive toxicity occurred.An adaptive reduction in chemotherapy dosage was required in 2 patients due to hematological toxicity,and a delay in chemotherapy cycles was required for 3 patients.CONCLUSION:FOLFIRI plus bevacizumab combination treatment showed promising efficacy and safety as second-line treatment for metastatic intrahepatic cholangiocarcinoma after failure of the first-line treatment of gemcitabine plus oxaliplatin chemotherapy.

原位杂交染色法检测SMAD4mRNA、P73mRNA在肝外胆管癌中的表达及临床意义

目的 通过检测SMAD4mRNA、P73mRNA在肝外胆管癌中表达 ,研究它们在肝外胆管癌发生、发展过程中的表达特点及相互关系、作用机制及其临床价值。方法 应用石蜡包块切片组织原位杂交染色法检测 4 2例肝外胆管癌中SMAD4mRNA、P73mRNA的表达 ,并以同期 2 0例慢性胆管炎作对照。结果 ①SMAD4mRNA阳性表达率为 6 1.90 % (2 6 /42 ) ,显著低于其相应良性对照组 (为 10 0 % ) ;P73mRNA表达率为 5 4 .76 % (2 3/42 ) ,显著高于相应良性对照组 (为 0 % )。②SMAD4mRNA、P73mRNA的表达与其临床病理分期及预后显著相关 (P <0 .0 5 ) ;SMAD4mRNA的表达与组织学分级及是否发生周围神经、血管、淋巴管浸润转移显著相关 (P <0 .0 5 )。③SMAD4mRNA、P73mRNA的表达两者呈负相关。结论 SMAD4mRNA、P73mRNA在肝外胆管癌中的表达反映了肝外胆管癌生物学特性 ,为预后判断提供参考指标 ,并为探索肝外胆管癌早期诊断和干预性基因治疗提供实验依据。