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Capecitabine has been proven effective as adjuvant chemotherapy for resectable biliary tract cancer (BTC). It also acts as a radiosensitizer that can be combined with transarterial radioembolization (TARE) to treat primary and secondary liver tumors. This study aims to evaluate the safety of TARE combined with adjuvant oral capecitabine (TARE+Cap) in treating unresectable BTC. A retrospective review was conducted on 32 consecutive patients with unresectable and biopsy-proven BTC that were treated with TARE+Cap at a single institution from May 2018 to August 2023 (average age 63.7 ± 11.0 years, female:male= 19:13 males. The dominant tumor had an average diameter of 5.7 ± 2.4 cm. In 8 of 32 patients (25%), disease burden was bilobar. The pre-TARE systemic treatments were as follows: Gemcitabine/Cisplatin (n=24), Gemcitabine/Cisplatin/Durvalumab (n=2), FOLFOX (n=2), Gemcitabine/Oxaliplatin (n=1), Gemcitabine/Oxaliplatin/Durvalumab (n=1), and none (n=2). After TARE, patients were given oral capecitabine (1,000 mg/m2) twice daily for 14 days within a 21-day cycle, for either 1 or 2 cycles. Major clinical and serological adverse events, as well as any post-TARE chemotherapy dose reductions or delays, were evaluated. A total of 41 segmental doses (293Gy ± 140.5Gy) and 27 lobar doses (165.0 ± 69.1Gy) were delivered, achieving local tumor control in 28 of 32 patients at 3-month follow-up (87.5%). Major adverse events occurred in 12 patients (37.5%). Patients who developed major adverse events displayed lower albumin levels (p=0.0031), elevated total bilirubin (p=0.0154), and poorer albumin-bilirubin (ALBI) scores/grades at baseline (p=0.0060 and p=0.0093, respectively). The presence of a biliary stent before TARE was linked to major adverse events (p=0.033). Logistic regression analysis verified that the ALBI score (p=0.013) and ALBI grade (p=0.016) were predictive of major adverse events. After TARE, chemotherapy was either delayed or given at a reduced dose for 9 of 27 patients (33.3%), which correlated with a worse ALBI score (p=0.045) and grade (p=0.047). High-dose TARE combined with adjuvant SIRT is feasible for patients with heavily treated unresectable BTC, showing promising local tumor control. The ALBI score/grade can predict post-TARE major adverse events as well as delays or reductions in post-TARE chemotherapy doses. The presence of a biliary stent may also be associated with worse clinical outcomes, which requires validation with a larger sample size.
Yu et al. (Wed,) studied this question.