Study offers new hope for patients with intrahepatic cholangiocarcinoma

Kandice Fogle, 43, had just moved to Houston when she began experiencing pain in her back and groin. After undergoing a CT scan, doctors found a large mass in her liver. A biopsy confirmed that she had intrahepatic cholangiocarcinoma, more commonly known as bile duct cancer.

After having the mass removed and undergoing chemotherapy and radiation treatment, her cancer returned six months later. Frightened that she would not live to see her two daughters, ages 9 and 5, grow up, she enrolled in a clinical trial to find out if liver transplant was a viable option for the treatment of her cancer.

"Previous studies reported very poor survival rates for patients with intrahepatic cholangiocarcinoma undergoing a liver transplant, so these patients have generally been ruled out for transplantation," said R. Mark Ghobrial, M.D., Ph.D., chief of liver transplantation at Houston Methodist J.C. Walter Jr. Transplant Center. "However, none of the prior studies treated patients with chemotherapy before removing the liver. We wanted see if we could shrink the tumor with chemotherapy, stabilize it for a few months and then perform a liver transplant."

In October, 2011, nearly three years after being diagnosed, Fogle got the call she had been waiting for.

"The day they told me my tumor had stopped growing, after undergoing months of intense chemotherapy treatments and having issues with my liver function, I was elated to have a second chance at life," Fogle said. "I knew it wasn't going to be easy, but I believed it was my only chance at seeing my kids grow up."

The study, conducted by Houston Methodist J.C. Walter Jr. Transplant Center and the University of Texas MD Anderson Cancer Center, accepted 12 patients with six receiving liver transplants. The survival rate was 100 percent at one year and 83 percent at five years with 50 percent of patients seeing no recurrence of their cancer more than five years after transplant. The findings appeared in a recent edition of The Lancet Gastroenterology and Hepatology.

"These results are promising, even in a small group of patients, because right now there's no cure for this disease if it cannot be surgically removed," said Milind Javle, M.D., professor of GI medical oncology and leader of the MD Anderson team. "We need to explore this approach further, and conduct large, multi-center trials to validate these results before determining that this therapy is the standard of care."

Ghobrial said most patients with intrahepatic cholangiocarcinoma were found to have this type of cancer only after they received a liver transplant and their old liver was removed. Many had instead been diagnosed with hepatocellular carcinoma, the most common form of liver cancer that occurs in patients with cirrhosis of the liver or hepatitis B or C

"I am encouraged by the results in this first group of patients and I hope we will be able to use this type of therapy to help more patients in the future," Ghobrial said.

Fogle is more than six years post-transplant and is still going strong. She has met her donor's family and is watching her daughters' grow up.

"I am so grateful for the extra time I have been given to be with my family," Fogle said. "We've celebrated so much together, seven more birthdays and Mother's Days, one high school graduation and another on the way. I am eternally grateful for each and every day I get to spend with my daughters."

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