Therapeutic Advances in Initially Unresectable Locally Advanced Intrahepatic Cholangiocarcinoma: Emerging Treatments and the Role of Liver Transplantation

Optimal curative therapy for intrahepatic cholangiocarcinoma (iCCA) involves hepatic resection; however, due to its insidious nature, iCCA frequently presents at advanced stages. Consequently, 70-80% of patients feature unresectable iCCA at presentation. Recent expansions in therapeutic options for locally advanced unresectable iCCA include immunotherapy, targeted chemotherapeutics, and liver-directed therapies. These have increased progression-free survival, enhanced response rates, and improved downstaging for resection. Liver transplant has also emerged as an alternative for patients whose tumors remain unresectable despite therapeutic response. Here, we explore emerging treatment options included in a multidisciplinary treatment paradigm to prolong survival in patients with initially unresectable locally advanced iCCA.