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A 67-year-old woman with MASLD, with compensated diabetes, overweight and arterial hypertension. She performed a CE-CT scan following the detection of 1 large focal liver lesions on abdominal US with at least two small satellite lesions. The CT scan confirmed 1 lesion of 56 mm in S3 with 4 lesions of 7-22 mm in the same segment, with evidence of vascular invasion of left portal branch, without biliary duct dilatation: radiological features suspicious for intrahepatic cholangiocarcinoma (iCCA). A chest-CT scan revealed 2 small nodules suspicious for metastases. She is asymptomatic in good general condition (ECOG PS 0), blood tests showed a serum bilirubin of 1.0 mg/dL, albumin 4.1 g/dL, AFP normal value, Ca 19.9 3x ULN. The patient, after histological confirmation of iCCA, is a candidate for treatment.

Which systemic first-line therapy should be considered in this patient with locally advanced, unresectable intrahepatic cholangiocarcinoma (iCCA) with a good performance status?

A. Chemotherapy with gemcitabine plus cisplatin, considering durvalumab only in second line.

B. Chemotherapy with gemcitabine plus cisplatin, with the addition of durvalumab where available.

C. Locoregional treatment should be always considered instead of systemic chemotherapy for iCCA.

D. Durvalumab monotherapy is the recommended first-line therapy in unresectable iCCA.

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