Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma: A propensity score

Thanks for posting this, Gavin! This is a really interesting study and, I think, an important one for people who are initially told that their cancer is “marginally resectable” (high risk), or whose doctors (as in the case of my mother) initially tell them that their cancer is unresectable, but who find themselves in the happy position of having a strong response to chemotherapy. Although this study is specifically relating to people whose cancers were staged I-III,  I am repeatedly struck by how often I run into examples in the literature of patients whose response to chemotherapy converts them from unresectable to having surgical options (for example, this fascinating study, which Gavin also posted on this site a while ago: https://www.ncbi.nlm.nih.gov/pubmed/28858392).

I think it is very common, especially at smaller hospitals, for patients whose cases are initially classified as “unresectable” to never be reassessed for surgical potential even if they experience significant shrinkage to their tumor. I know that in my mother’s case it took all of us aggressively seeking 2nd opinions, and not just at the beginning of the process but after we’d gone through multiple cycles of the chemo and the scans had shown improvement, in order to get surgery on the table for her. It’s hard to know what might have happened if we hadn’t gone out looking for those 2nd opinions, but I strongly suspect we might have been put onto a ‘holding pattern’ chemo regime and missed our chance at the surgery, if we hadn’t advocated so strongly.

It is really encouraging to see that the ‘neoadjuvant’ therapy, which is essentially what my mom had, is associated with such promising numbers (and for what it is worth, my mom is about to also get a few rounds of adjuvant therapy, so here’s hoping for a ‘best of both worlds’ result).