Combined photodynamic therapy with systemic chemotherapy for unresectable cholangiocarcinoma

Abstract

Summary Background Chemotherapy with gemcitabine and cisplatin is the current standard for patients with unresectable cholangiocarcinoma. Local photodynamic therapy has also demonstrated benefit in patients with extrahepatic cholangiocarcinoma. Aim To evaluate the benefit of photodynamic therapy in combination with systemic chemotherapy in advanced extrahepatic cholangiocarcinoma. Methods Three hundred and fifty‐three patients diagnosed with cholangiocarcinoma between 2004 and 2016 were treated at the University Hospital of Bonn, Germany. Of these, 96 suffering from unresectable extrahepatic cholangiocarcinoma were included. Patients were stratified according to treatment: combination photodynamic therapy and chemotherapy (36 patients), photodynamic therapy alone (34 patients), and chemotherapy alone (26 patients). Results Combined photodynamic therapy with chemotherapy resulted in significantly longer overall survival than chemotherapy alone (P = 0.022). Median survival was 20 months in the combination group (95% CI: 16.38‐23.62), 15 months in the photodynamic alone group (95% CI: 10.02‐19.98) and 10 months in the chemotherapy alone group (95% CI: 8.45‐11.55). In multivariate analysis, combination therapy and photodynamic therapy alone (HR: 0.41, 95% CI: 0.22‐0.77, P = 0.006), metal stenting, and radiofrequency ablation were independent predictors of longer survival. Conclusions Combination photodynamic therapy and chemotherapy was well tolerated and resulted in significantly longer survival than chemotherapy alone. Application of photodynamic therapy significantly correlated with longer survival, demonstrating benefit in advanced cholangiocarcinoma. Thus, photodynamic therapy should be considered during therapeutic decision making in advanced cholangiocarcinoma.

Photodynamic therapy for solid tumors: A review of the literature

“…Application of PDT is significantly correlated with longer survival in advanced cholangiocarcinoma. 42 In another study comparing PDT to endoprostheses alone, median survival time for PDT was significantly longer (21 months vs 7 months, P = 0.0109), though cholangitis was more common with PDT. 43 PDT in conjunction with chemotherapy has been shown to have significantly higher rates of 1-year survival than PDT alone.…”

“…While chemotherapy with gemcitabine and cisplatin is current standard of care for patients with advanced cholangiocarcinoma, a recent study of 96 patients with advanced unresectable cholangiocarcinoma suggests combination of PDT with CRT improves overall survival (median 20 months, 95% CI 16.38‐23.62) compared to PDT alone (15 months, 95% CI 10.02‐19.98) and chemotherapy alone (10 months, 95% CI 8.45‐11.55). Application of PDT is significantly correlated with longer survival in advanced cholangiocarcinoma . In another study comparing PDT to endoprostheses alone, median survival time for PDT was significantly longer (21 months vs 7 months, P = 0.0109), though cholangitis was more common with PDT .…”

Editorial: shining a light on cholangiocarcinoma—a new dawn for photodynamic therapy? Authors’ reply

“…The authors’ declarations of personal and financial interests are unchanged from those in the original article …”

“…The answer to this question may be a “yes” if you take into account that our study is reporting on a further step of evidence for the use of photodynamic therapy (PDT), namely in combination with standard palliative chemotherapy, in patients with extrahepatic cholangiocarcinoma …”

Editorial: shining a light on cholangiocarcinoma—a new dawn for photodynamic therapy?

“…In a recent issue of Alimentary Pharmacology & Therapeutics , Gonzalez‐Carmona et al from Germany present data from a three‐armed study comparing combination treatment with photodynamic therapy (PDT) and SC to PDT and SC alone in patients with unresectable cholangiocarcinoma . The longest median survival was in the combination group (20 months) and interestingly, survival in patients receiving PDT (15 months) exceeded that in SC alone (10 months).…”