FOLFOX-HAIC versus first-line systemic chemotherapy in HBsAg-positive patients with unresectable intrahepatic cholangiocarcinoma: A propensity score matched cohort study.

Authors

Min-Rui He, Yang-Xun Pan, Tian-Qing Wu, Zhi-Kai Zheng, Yu-Han Zhang, Jin-Bin Chen, Dan-Dan Hu, Li Xu, Yao-Jun Zhang, Min-Shan Chen, Jun-Cheng Wang, Zhong-Guo Zhou

Published in

Hepatobiliary & pancreatic diseases international : HBPD INT. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

The optimal treatment strategy for hepatitis B surface antigen (HBsAg)-positive patients with unresectable intrahepatic cholangiocarcinoma (ICC) remains unclear. This study aimed to compare the efficacy and safety of FOLFOX (oxaliplatin, 5-fluorouracil, and leucovorin)-based hepatic arterial infusion chemotherapy (HAIC) versus first-line systemic chemotherapy (SC) in this population to identify a more effective treatment.
We included 165 HBsAg-positive patients with unresectable ICC treated at Sun Yat-sen University Cancer Center from July 2015 to April 2024. After propensity score matching, 68 patients were assigned to each group. The matched cohorts were compared in terms of progression-free survival (PFS), intrahepatic PFS, overall survival (OS), objective response rate (ORR), disease control rate (DCR) and safety.
Compared to the SC group, the HAIC group demonstrated significantly longer median PFS (6.90 vs. 4.53 months; P < 0.001) and intrahepatic PFS (10.00 vs. 8.20 months; P = 0.006). The ORR was also significantly higher in the HAIC group according to both Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) (38% vs. 15%; P = 0.004) and modified Response Evaluation Criteria in Solid Tumors (mRECIST) (43% vs. 15%; P = 0.001) criteria. Conversion surgery was achieved in 14 patients (21%) in the HAIC group versus 1 patient (1%) in the SC group (P = 0.001). The incidence of any grade (P = 0.476) and grade 3-4 (P = 0.384) adverse events were comparable between the two groups.
In HBsAg-positive patients with unresectable ICC, FOLFOX-HAIC provided superior local control with a trend toward improved long-term prognosis compared to SC while maintaining an acceptable safety profile.

PMID:
42618446
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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