Management of locally advanced intrahepatic cholangiocarcinoma: a narrative review

Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive primary hepatic malignancy, which has increased in incidence over the past decades. While surgical resection is the standard of care for patients with early-staged disease, many patients present with locally advanced and unresectable tumors. Given the importance of locoregional control and the potential for downstaging to resectability, knowledge of advances in the management of locally advanced ICC is critical for optimizing outcomes.Methods and Objective: This is a narrative review providing an up-to-date summary of the current literature regarding contemporary management of locally advanced ICC including systemic and liverdirected therapies. Key Content and Findings: Along with systemic chemotherapy, several liver-directed therapies including transarterial chemoembolization, transarterial radioembolization, and hepatic artery infusion pumps, targeted therapies, and chemoradiation therapy have demonstrated promising results for improving local disease control and possibly extending survival. Unfortunately, successful downstaging to resection remains uncommon with no single treatment strategy established as standard of care. Although additional randomized controlled data are needed, multidisciplinary management using contemporary systemic and locoregional therapies improves outcomes for patients with locally advanced ICC.Conclusions: The optimal management of locally advanced ICC remains uncertain. Despite this, novel treatment options and ongoing clinical trials are currently contributing to more effective treatment and improved patient outcomes. Future advancements are likely to explore further novel therapies in addition to elucidating optimal patient selection and sequencing of multidisciplinary therapy.